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General NPI Number Information
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NPI Number | 1073505467
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Entity Type | Individual
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Provider Name | LINDA D RETTGER M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 18 W MAIN ST
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City | MT JEWETT
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State | PA
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Zip | 16740-0000
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Country | US
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Telephone | 814-778-2298
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Fax | 814-778-7344
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Provider Business Mailing Address
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Address Line | 4372 ROUTE 6
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City | KANE
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State | PA
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Zip | 16735-3060
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Country | US
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Telephone | 814-778-2298
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Fax | 814-778-7344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD020312E
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License Number State | PA
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