Provider Demographics
NPI:1851411656
Name:GERALD J. RIFFELMACHER, M.D., PC
Entity type:Organization
Organization Name:GERALD J. RIFFELMACHER, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RIFFELMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-395-7638
Mailing Address - Street 1:0 GOVERNORS AVE
Mailing Address - Street 2:SUITE 33
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3025
Mailing Address - Country:US
Mailing Address - Phone:781-395-7638
Mailing Address - Fax:
Practice Address - Street 1:0 GOVERNORS AVE
Practice Address - Street 2:SUITE 33
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3025
Practice Address - Country:US
Practice Address - Phone:781-395-7638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5625342OtherAETNA
MA701485AOtherTUFTS HEALTH PLAN
MA9720618Medicaid
MAM13320OtherBLUE SHIELD
MA3357OtherHARVARD PILGRIM HEALTHCAR
MA3357OtherHARVARD PILGRIM HEALTHCAR
MA701485AOtherTUFTS HEALTH PLAN
MA9720618Medicaid