Provider Demographics
NPI:1114180601
Name:RICHARD R RUTH DO PC
Entity Type:Organization
Organization Name:RICHARD R RUTH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROSENBERGER
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-723-7731
Mailing Address - Street 1:200 WEST CHERRY LANE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1987
Mailing Address - Country:US
Mailing Address - Phone:215-723-7731
Mailing Address - Fax:215-723-7855
Practice Address - Street 1:200 WEST CHERRY LANE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1987
Practice Address - Country:US
Practice Address - Phone:215-723-7731
Practice Address - Fax:215-723-7855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD R RUTH DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001893L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001949545OtherHIGHMARK
PA041448Medicare PIN