Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD018887E | PA |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD018887E | PA |
N | 207XS0117X | Orthopaedic Spine Surgeon | MD018887E | PA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD018887E | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD018887E | PA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | MD018887E | PA |
NPI | 1124015797 |
---|---|
Provider Name | Peter James Ridella |
First Address | Johnstown, PA 15905-4330 |
Second Address | Johnstown, PA 15905-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 18/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007978670002 | (05) | PA |
B34802 | (02) |