Provider Demographics
NPI:1194709774
Name:RUGGIERO, ROBERT PAUL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:2ND TPI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-926-9019
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:2230 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-634-3418
Practice Address - Fax:215-364-4872
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022286E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4072OtherBRAVO HEALTH
PA0069532006OtherAMERICHOICE
PA30027786OtherKEYSTONE MERCY HEALTH
PA000695320Medicaid
PA0052025000OtherINDEPENDENCE BLUE CROSS
PA0878458OtherCIGNA
PA099036OtherHIGHMARK BLUE SHIELD
PA3Y7470OtherHEALTH NET
PA571685OtherCOVENTRY HEALTH AMERICA
PA597586OtherTEMPLE PHYSICIANS INC MEDICARE GROUP
PA1169689OtherAETNA HMO
PA4076296OtherAETNA PPO
PA597586Medicare PIN
PA597586OtherTEMPLE PHYSICIANS INC MEDICARE GROUP
B36345Medicare UPIN