Provider Demographics
NPI:1578646857
Name:RITTENHOUSE, ROBERT N (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:RITTENHOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-481-0200
Mailing Address - Fax:508-229-2343
Practice Address - Street 1:640 BOLTON ST
Practice Address - Street 2:LAKEVIEW MEDICAL ASSOC
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-481-0200
Practice Address - Fax:508-229-2343
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA024991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2009242Medicaid
MAB22012Medicare ID - Type Unspecified
A34573Medicare UPIN