Provider Demographics
NPI:1770732133
Name:RIDBERG, EUGENE H (PHD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:H
Last Name:RIDBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 CONNECTICUT AVE.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3910
Mailing Address - Country:US
Mailing Address - Phone:301-946-5180
Mailing Address - Fax:301-942-2026
Practice Address - Street 1:10400 CONNECTICUT AVE.
Practice Address - Street 2:SUITE 303
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3910
Practice Address - Country:US
Practice Address - Phone:301-946-5180
Practice Address - Fax:301-942-2026
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
046986Medicare PIN