Provider Demographics
NPI:1720425929
Name:ATLANTIC HEALTH CARE PLLC
Entity Type:Organization
Organization Name:ATLANTIC HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-651-8180
Mailing Address - Street 1:359 YORK RD
Mailing Address - Street 2:STORE FRONT
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2621
Mailing Address - Country:US
Mailing Address - Phone:215-366-7141
Mailing Address - Fax:215-933-3120
Practice Address - Street 1:359 YORK RD
Practice Address - Street 2:STORE FRONT
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2621
Practice Address - Country:US
Practice Address - Phone:215-366-7141
Practice Address - Fax:215-933-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422681207L00000X, 208VP0014X
PAMD442471207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAPPLIEDOtherIBC