Provider Demographics
NPI:1982621629
Name:RITSEMA, RITA LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:LORRAINE
Last Name:RITSEMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WEST CHESTER PIKE
Mailing Address - Street 2:STE #202
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3442
Mailing Address - Country:US
Mailing Address - Phone:610-789-3510
Mailing Address - Fax:610-789-3591
Practice Address - Street 1:1010 WEST CHESTER PIKE
Practice Address - Street 2:STE #202
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3442
Practice Address - Country:US
Practice Address - Phone:610-789-3510
Practice Address - Fax:610-789-3591
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033108E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116809903Medicaid
471874FQHMedicare ID - Type Unspecified
PA116809903Medicaid