Provider Demographics
NPI:1861544363
Name:TRISTATE SURGEONS, LLC
Entity type:Organization
Organization Name:TRISTATE SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-513-4601
Mailing Address - Street 1:1110 PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:240-513-4601
Mailing Address - Fax:240-513-4602
Practice Address - Street 1:1110 PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:240-513-4601
Practice Address - Fax:240-513-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015851650002Medicaid
MD54499100Medicaid
MD813MMedicare ID - Type Unspecified
PA075888Medicare PIN
PA1015851650002Medicaid
MD54499100Medicaid