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General NPI Number Information
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NPI Number | 1568468692
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Entity Type | Individual
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Provider Name | LEONARD V RIDILLA MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 15 E REDMAN AVE
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2316
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Country | US
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Telephone | 856-428-1335
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Fax | 856-428-6334
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Provider Business Mailing Address
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Address Line | 15 E REDMAN AVE
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2316
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Country | US
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Telephone | 856-428-1335
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Fax | 856-428-6334
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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 | MA05731800
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License Number State | PA
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