Provider Demographics
NPI:1376520593
Name:RITTENHOUSE, ERIC RAY (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RAY
Last Name:RITTENHOUSE
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 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-253-8226
Mailing Address - Fax:570-253-8228
Practice Address - Street 1:626 PARK ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1446
Practice Address - Country:US
Practice Address - Phone:570-253-3005
Practice Address - Fax:570-253-0181
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050588L207V00000X
PA050588L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1506473OtherGATEWAY
PA1511442OtherGATEWAY GROUP #
PA0268906000OtherKHPE GROUP #
PA993220OtherKEYSTONE HEALTH PLAN CENT
PA0016201900003Medicaid
PA0780707000OtherKEYSTONE HEALTH PLAN EAST
PA01053001OtherCAP BLUE CROSS
PA02294500OtherCAP BLUECROSS GROUP #
PA1048305OtherAMERIHEALTH MERCY
PA124389OtherPA BLUE SHIELD GROUP #
PA500134OtherAETNA GROUP NUMBER
PA642963OtherPA BLUE SHIELD
PA74731OtherMEDPLUS
PA4611221OtherAETNA
PA048415Medicare ID - Type UnspecifiedGROUP #
PA0268906000OtherKHPE GROUP #
PA1048305OtherAMERIHEALTH MERCY