Provider Demographics
NPI:1073996930
Name:RITTWAGE, MARIAH K (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:K
Last Name:RITTWAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:K
Other - Last Name:EASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:607-324-5404
Mailing Address - Fax:607-324-5463
Practice Address - Street 1:111 LODER ST STE A
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1950
Practice Address - Country:US
Practice Address - Phone:607-324-5404
Practice Address - Fax:607-324-5463
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21892363AM0700X
NY021892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical