Provider Demographics
NPI:1891943718
Name:RISING, KRISTIN L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:RISING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SANSOM ST
Mailing Address - Street 2:SUITE 239
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5002
Mailing Address - Country:US
Mailing Address - Phone:215-955-6844
Mailing Address - Fax:215-955-5686
Practice Address - Street 1:1020 SANSOM ST
Practice Address - Street 2:SUITE 239
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5002
Practice Address - Country:US
Practice Address - Phone:215-955-6844
Practice Address - Fax:215-955-5686
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445373207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102709042 0002Medicaid
NJ0291579Medicaid
PA240947Medicare PIN