Provider Demographics
NPI:1073507638
Name:RITTENBERRY, ANDREW B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:RITTENBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-778-8212
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:STE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3323
Practice Address - Country:US
Practice Address - Phone:423-624-6993
Practice Address - Fax:423-622-7366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2566564 001OtherCIGNA
62165877454OtherJDH
1740003OtherUHC
3076749OtherBCBS OF TN
GA00199361CMedicaid
TN3171219Medicaid
3171213Medicare ID - Type Unspecified
3171214Medicare ID - Type Unspecified
TN3171219Medicaid
62165877454OtherJDH