Basic Information
| Provider Information | |||||||||
| NPI: | 1437211307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITTEN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LECOM PL | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165052571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148682507 | ||||||||
| FaxNumber: | 8148682522 | ||||||||
| Practice Location | |||||||||
| Address1: | 328 YORK STREET | ||||||||
| Address2: | |||||||||
| City: | CORRY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146633030 | ||||||||
| FaxNumber: | 8146634105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301051496 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0000X | MD444258 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 3025372 | 05 | OH | MEDICAID | 160440052 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1030642100004 | 05 | PA | MEDICAID | 383265735 | 01 | MI | TAX ID | OTHER | 3225550 | 05 | MI | MEDICAID |