Healthcare Provider Details

I. General information

NPI: 1902800501
Provider Name (Legal Business Name): PHILIP L RICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RADNOR RD SUITE 201
STATE COLLEGE PA
16801-7986
US

IV. Provider business mailing address

100 RADNOR RD SUITE 201
STATE COLLEGE PA
16801-7986
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-2616
  • Fax: 814-238-0541
Mailing address:
  • Phone: 814-238-2616
  • Fax: 814-238-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD060088L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016582690003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: