Provider Demographics
NPI:1073557138
Name:LANDEFELD, RALPH EDWIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWIN
Last Name:LANDEFELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10159 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6323
Mailing Address - Country:US
Mailing Address - Phone:724-601-4901
Mailing Address - Fax:814-336-5388
Practice Address - Street 1:10159 NANCY DR
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-6323
Practice Address - Country:US
Practice Address - Phone:724-601-4901
Practice Address - Fax:814-336-5388
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002990-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0146700Medicaid
400564Q6TMedicare ID - Type Unspecified
PA0146700Medicaid