Provider Demographics
NPI:1801063714
Name:RITCH DE HERRERA, THADDEUS (MD)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:
Last Name:RITCH DE HERRERA
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 1:5080 SPECTRUM DR STE 1200W
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4624
Mailing Address - Country:US
Mailing Address - Phone:972-364-8083
Mailing Address - Fax:147-754-5022
Practice Address - Street 1:2804 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1207
Practice Address - Country:US
Practice Address - Phone:215-677-0930
Practice Address - Fax:215-677-3266
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0929600207Q00000X
PAMD478812207Q00000X, 2083X0100X
NMMD2011-0549207R00000X, 207Q00000X
NJ25MA092960002083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine