Healthcare Provider Details

I. General information

NPI: 1194709774
Provider Name (Legal Business Name): ROBERT PAUL RUGGIERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 E ALLEGHENY AVE
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE 2ND TPI
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-634-3418
  • Fax: 215-364-4872
Mailing address:
  • Phone: 215-926-9019
  • Fax: 215-226-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD022286E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: