Provider Demographics
NPI:1588446629
Name:RIDDLE VILLAGE
Entity type:Organization
Organization Name:RIDDLE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-891-3806
Mailing Address - Street 1:1048 W BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5168
Mailing Address - Country:US
Mailing Address - Phone:484-621-1100
Mailing Address - Fax:610-627-4789
Practice Address - Street 1:1048 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5168
Practice Address - Country:US
Practice Address - Phone:484-621-1100
Practice Address - Fax:610-627-4789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIDDLE VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty