Provider Demographics
NPI:1982747705
Name:RITVO, RACHEL ZEPORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ZEPORAH
Last Name:RITVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3820
Mailing Address - Country:US
Mailing Address - Phone:301-946-9229
Mailing Address - Fax:301-946-9228
Practice Address - Street 1:4020 EVERETT ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3820
Practice Address - Country:US
Practice Address - Phone:301-946-9229
Practice Address - Fax:301-946-9228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD257652084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI557078Medicare ID - Type Unspecified
E13469Medicare UPIN