Provider Demographics
NPI:1477751584
Name:RITTENHOUSE, RICHARD W (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:RITTENHOUSE
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 1:122554 RIATA VISTA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122554 RIATA VISTA CIRCLE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4518
Practice Address - Country:US
Practice Address - Phone:512-956-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0089402085R0202X
CA188362085R0202X
CT680182085R0202X
DEC2-00238732085R0202X
TXT0362085R0202X
MN495972085R0202X
GA871482085R0202X
IL036.1542192085R0202X
IN02006146A2085R0202X
IADO-056872085R0202X
KY048162085R0202X
LA3335352085R0202X
MI51010258602085R0202X
MO25MB110144002085R0202X
FLOS172002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN687400000Medicaid
MN300004199Medicare PIN