Healthcare Provider Details

I. General information

NPI: 1962587873
Provider Name (Legal Business Name): RIDDLE HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W BALTIMORE PIKE OUT PATIENT PAV SUITE 3303
MEDIA PA
19063-5104
US

IV. Provider business mailing address

1068 W BALTIMORE PIKE OUT PATIENT PAV SUITE 3303
MEDIA PA
19063-5104
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-3490
  • Fax: 610-891-3493
Mailing address:
  • Phone: 610-891-3490
  • Fax: 610-891-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA BAILEY
Title or Position: DIRECTOR OF RNWMC
Credential:
Phone: 610-891-3490