Provider Demographics
NPI:1073505467
Name:RETTGER, LINDA D (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:D
Last Name:RETTGER
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 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-778-2298
Mailing Address - Fax:814-778-7344
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT JEWETT
Practice Address - State:PA
Practice Address - Zip Code:16740-0000
Practice Address - Country:US
Practice Address - Phone:814-778-2298
Practice Address - Fax:814-778-7344
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020312E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000044064OtherHIGHMARK BC/BS PROVIDER #
PA010047693OtherPALMETTO GBA PROVIDER #
PA0006112770002Medicaid
PA217622OtherUPMC PROVIDER NUMBER
PAMD020312EOtherMEDICAL LICENSE NUMBER
PA000044064OtherHIGHMARK BC/BS PROVIDER #
PA217622OtherUPMC PROVIDER NUMBER
PAB34274Medicare UPIN