Provider Demographics
NPI:1124053293
Name:TADDONIO, RICHARD BRUCE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRUCE
Last Name:TADDONIO
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 1:333 N OXFORD VALLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-946-1500
Mailing Address - Fax:215-946-3417
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:STE 201
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-946-1500
Practice Address - Fax:215-946-3417
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023981-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TA401270Medicare ID - Type Unspecified
B41211Medicare UPIN