Provider Demographics
NPI:1699791566
Name:MARCUS RIEDHAMMER, MD, PC
Entity type:Organization
Organization Name:MARCUS RIEDHAMMER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEDHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-769-7941
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:WOOLRICH
Mailing Address - State:PA
Mailing Address - Zip Code:17779-0169
Mailing Address - Country:US
Mailing Address - Phone:570-748-7901
Mailing Address - Fax:570-769-7942
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-326-8550
Practice Address - Fax:570-326-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH54955Medicare UPIN