Healthcare Provider Details

I. General information

NPI: 1144337015
Provider Name (Legal Business Name): RIDDLE HEALTHCARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W BALTIMORE PIKE SUITE #2208
MEDIA PA
19063-5146
US

IV. Provider business mailing address

1088 W BALTIMORE PIKE SUITE #2208
MEDIA PA
19063-5146
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-3900
  • Fax: 610-891-3919
Mailing address:
  • Phone: 610-891-3900
  • Fax: 610-891-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA BLAIR
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 610-627-4216