Provider Demographics
NPI:1821192964
Name:RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.
Entity type:Organization
Organization Name:RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PMR
Authorized Official - Phone:610-644-6900
Mailing Address - Street 1:266 LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3256
Mailing Address - Country:US
Mailing Address - Phone:610-644-6900
Mailing Address - Fax:610-644-7160
Practice Address - Street 1:266 LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-644-6900
Practice Address - Fax:610-644-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC6125OtherMEDICARE RAILROAD
PACC6125OtherMEDICARE RAILROAD
PA639494Medicare PIN