Provider Demographics
NPI:1730164245
Name:RITTER, MARC DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:RITTER
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 1:3136 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-2800
Mailing Address - Country:US
Mailing Address - Phone:315-737-3522
Mailing Address - Fax:315-737-3526
Practice Address - Street 1:3136 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:SAUQUOIT
Practice Address - State:NY
Practice Address - Zip Code:13456-2800
Practice Address - Country:US
Practice Address - Phone:315-737-3522
Practice Address - Fax:315-737-3526
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01020855Medicaid