Basic Information
| Provider Information | |||||||||
| NPI: | 1073505467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RETTGER | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147782298 | ||||||||
| FaxNumber: | 8147787344 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MT JEWETT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167400000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147782298 | ||||||||
| FaxNumber: | 8147787344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD020312E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000044064 | 01 | PA | HIGHMARK BC/BS PROVIDER # | OTHER | 010047693 | 01 | PA | PALMETTO GBA PROVIDER # | OTHER | 0006112770002 | 05 | PA | MEDICAID | 217622 | 01 | PA | UPMC PROVIDER NUMBER | OTHER | MD020312E | 01 | PA | MEDICAL LICENSE NUMBER | OTHER |