MEDICARE: SHANE RUCKLE MD

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	207P00000X	Emergency Medicine Physician	241661	NY
2	207P00000X	Emergency Medicine Physician	V1699	TX
3	207P00000X	Emergency Medicine Physician	4490	WI
4	207P00000X	Emergency Medicine Physician	MD067927L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932133907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE RUCKLE MD

Provider Business Mailing Address
First Line	:	3624 MARKET ST
Second Line	:	SUITE 560W
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2614
Country	:	US
Telephone Number	:	215-662-2286
Fax Number	:	215-615-0500

Provider Business Practice Location Address
First Line	:	800 SPRUCE ST
Second Line	:	2 CATHCART
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-3264
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/29/2026

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Directions to “ SHANE RUCKLE MD” Practice Location

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