Healthcare Provider Details

I. General information

NPI: 1821192964
Provider Name (Legal Business Name): RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/20/2007
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 NumberMD424317
License Number StatePA

VIII. Authorized Official

Name: MICHAEL S LEE
Title or Position: PHYSIATRIST
Credential: P.M.R
Phone: 610-644-6900