Provider Demographics
NPI:1306829205
Name:RIGGLE, MARTHA A
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:RIGGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N WALNUT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4738
Mailing Address - Country:US
Mailing Address - Phone:301-745-3777
Mailing Address - Fax:
Practice Address - Street 1:24 N WALNUT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4738
Practice Address - Country:US
Practice Address - Phone:301-745-3777
Practice Address - Fax:301-733-5731
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD1138968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410662900Medicaid
E21348Medicare UPIN
MD410662900Medicaid