Provider Demographics
NPI:1093728453
Name:PICKERING FAMILY PRACTICE
Entity Type:Organization
Organization Name:PICKERING FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-363-0248
Mailing Address - Street 1:605 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1287
Mailing Address - Country:US
Mailing Address - Phone:610-363-0248
Mailing Address - Fax:610-363-4004
Practice Address - Street 1:605 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1287
Practice Address - Country:US
Practice Address - Phone:610-363-0248
Practice Address - Fax:610-363-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004818L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty