Provider Demographics
NPI:1982224655
Name:ERIC RICKIN MD LLC
Entity Type:Organization
Organization Name:ERIC RICKIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RICKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-407-7876
Mailing Address - Street 1:1386 OLD FREEPORT RD STE 1AF
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3115
Mailing Address - Country:US
Mailing Address - Phone:412-407-7876
Mailing Address - Fax:918-398-9125
Practice Address - Street 1:1386 OLD FREEPORT RD STE 1AF
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3115
Practice Address - Country:US
Practice Address - Phone:412-407-7876
Practice Address - Fax:918-398-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101375417Medicaid