Provider Demographics
NPI:1457351900
Name:RIFFELMACHER, GERALD JOHN (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:JOHN
Last Name:RIFFELMACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-395-7638
Mailing Address - Fax:781-395-2915
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-395-7638
Practice Address - Fax:781-395-2915
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA43699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2066602Medicaid
MA3357OtherHARVARD PILGRIM HEALTHCAR
MA701485OtherTUFTS HEALTH PLAN
MAA35123Medicare UPIN
MAB30158Medicare PIN