Healthcare Provider Details

I. General information

NPI: 1255342705
Provider Name (Legal Business Name): ROBERT A RUGGIERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 LANCASTER AVE SUITE 200
MALVERN PA
19355-3256
US

IV. Provider business mailing address

266 LANCASTER AVE. SUITE 200
MALVERN PA
19355-3256
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6900
  • Fax: 610-644-7160
Mailing address:
  • Phone: 610-644-6900
  • Fax: 610-644-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD010219E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: