Provider Demographics
NPI:1164472486
Name:RUPPERSBERGER, ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RUPPERSBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1532
Mailing Address - Country:US
Mailing Address - Phone:215-949-1125
Mailing Address - Fax:215-949-6004
Practice Address - Street 1:1530 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1532
Practice Address - Country:US
Practice Address - Phone:215-949-1125
Practice Address - Fax:215-949-6004
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012583400005Medicaid
PA30023590OtherKEYSTONE MERCY
PA1012583400002Medicaid
PA1012583400004Medicaid
PA2459092OtherUNITED HEALTHCARE
PA2179736000OtherIBC, KEYSTONE
PA35651OtherHEALTH PARTNERS
PA101258340-01OtherAMERICHOICE
PA1490043OtherPERSONAL CHOICE
PA1012583400003Medicaid
PA1490043OtherHIGHMARK BLUE SHIELD
PA3193133OtherAETNA
PA7172572OtherCIGNA
PA3193133OtherAETNA
PA1012583400004Medicaid