Provider Demographics
NPI:1598839813
Name:RIDKY, TODD W (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:RIDKY
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 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:1-330S PERELMAN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-662-2737
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:1-330S PERELMAN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73182207N00000X
PAMD440722207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731820Medicaid
H75068Medicare UPIN
CA00A731820Medicaid