Provider Demographics
NPI:1750302881
Name:REDWOOD PEDIATRIC AND ADOLESCENT MEDICINE, LLC
Entity Type:Organization
Organization Name:REDWOOD PEDIATRIC AND ADOLESCENT MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-787-2555
Mailing Address - Street 1:15 VREELAND AVE
Mailing Address - Street 2:
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1631
Mailing Address - Country:US
Mailing Address - Phone:413-787-2555
Mailing Address - Fax:413-787-9992
Practice Address - Street 1:15 VREELAND AVE
Practice Address - Street 2:
Practice Address - City:E LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1631
Practice Address - Country:US
Practice Address - Phone:413-787-2555
Practice Address - Fax:413-787-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty