Healthcare Provider Details

I. General information

NPI: 1699791566
Provider Name (Legal Business Name): MARCUS RIEDHAMMER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GRAMPIAN BLVD 4TH FLOOR
WILLIAMSPORT PA
17701-1909
US

IV. Provider business mailing address

PO BOX 169
WOOLRICH PA
17779-0169
US

V. Phone/Fax

Practice location:
  • Phone: 570-326-8550
  • Fax: 570-326-8551
Mailing address:
  • Phone: 570-748-7901
  • Fax: 570-769-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCUS RIEDHAMMER
Title or Position: PRESIDENT
Credential: MD
Phone: 570-769-7941