Provider Demographics
NPI:1942261375
Name:RITTENBERG, MICHAEL HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARRIS
Last Name:RITTENBERG
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 1:423 3RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5809
Mailing Address - Country:US
Mailing Address - Phone:570-288-3601
Mailing Address - Fax:570-288-1726
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-288-3601
Practice Address - Fax:570-288-1726
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-027471-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000075915OtherMEDPLUS
PA2Y3801OtherHEALTHNET
PA0900660001OtherMEDICARE DME
PA505911OtherUNITED HEALTHCARE
PA077284OtherFIRST PRIORITY HEALTH
PA121680OtherBLUE CROSS/BLUE SHIELD
20010385OtherAMERIHEALTH MERCY
PA0010980000002Medicaid
PA340009432OtherTRAVELER'S RAILROAD MEDIC
DC01042501OtherCAPITAL BLUE CROSS
PA10518 6365OtherGEISINGER HEALTH PLAN