MEDICARE: DR. DANIEL EGBERT RUCKDESCHEL PHD

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	103T00000X	Psychologist	PS018242	PA

General Provider Information

NPI Number	:	1437646957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL EGBERT RUCKDESCHEL PHD

Provider Business Mailing Address
First Line	:	4320 SALINE ST APT 1
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-2912
Country	:	US
Telephone Number	:	347-420-0284
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 CHESTNUT ST STE 303
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3024
Country	:	US
Telephone Number	:	215-399-4128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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