Basic Information
| Provider Information | |||||||||
| NPI: | 1801063714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RITCH DE HERRERA | ||||||||
| FirstName: | THADDEUS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DR STE 1200W | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723648083 | ||||||||
| FaxNumber: | 1477545022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2804 SOUTHAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191541207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156770930 | ||||||||
| FaxNumber: | 2156773266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2008 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD2011-0549 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2083P0500X | 25MA09296000 | NJ | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 2083X0100X | 25MA09296000 | NJ | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083X0100X | MD478812 | PA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.