MEDICARE: RIDDLE ENDOCRINOLOGY & METABOLISM ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD035193E	PA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD436772	PA

General Provider Information

NPI Number	:	1164659140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDDLE ENDOCRINOLOGY & METABOLISM ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	PO BOX 1897
Second Line	:
City	:	BOOTHWYN
State	:	PA
Zip	:	19061-7897
Country	:	US
Telephone Number	:	610-876-2300
Fax Number	:	610-876-3004

Provider Business Practice Location Address
First Line	:	2901 DUTTON MILL RD
Second Line	:	STE 110
City	:	ASTON
State	:	PA
Zip	:	19014-2849
Country	:	US
Telephone Number	:	610-876-2300
Fax Number	:	610-876-3004

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. REX KEITH KESSLER
Credential	:	MD
Telephone Number	:	610-876-2300

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	10/03/2012

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