Individual
ELLEN PATRICIA NOLAN RICCOBENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9331 OLD BUSTLETON AVE, STE 201, PHILADELPHIA, PA 19115
(215) 602-8500
(215) 676-6507
Mailing address
2450 W HUNTING PARK AVE, 2ND TPI, PHILADELPHIA, PA 19129-1302
(215) 926-9019
(215) 226-8286
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M2419567
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10515
BRAVO HEALTH
PA
01
—
1413820
HIGHMARK BLUE SHIELD
PA
01
—
2100579000
INDEPENDENCE BLUE CROSS
PA
01
—
2968415
AETNA PPO
PA
01
—
3009673
KEYSTONE MERCY HEALTH
PA
01
—
3209011
AETNA HMO
PA
01
—
3Y4906
HEALTH NET
PA
01
—
P00025010
RAILROAD MEDICARE
PA
Enumeration date
12/01/2005
Last updated
08/16/2007
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