Provider Demographics
NPI:1265428197
Name:RITTENBERGER, JON C (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:RITTENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:570-888-5858
Practice Address - Street 1:1 GUTHRIE SQ DEPT OF
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301705-01207P00000X
PAMD424700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00262611OtherRR MEDICARE
PA000000168442OtherUNISON
PA1624446OtherBCBS PA
PA1540340OtherGATEWAY
PA2673763OtherOHIO MEDICAID
PA701511OtherUPMC
PA7389515OtherCIGNA
PA101045510Medicaid
PA000000168442OtherUNISON
PA1624446OtherBCBS PA