| Elijah Wade Riddle, MD | |
| 735 Norman Dr Ste 3, Lebanon, PA 17042-7559 | |
| (717) 270-7908 | |
| (717) 272-1734 | 
| Full Name | Elijah Wade Riddle | 
|---|---|
| Gender | Male | 
| Speciality | Surgery - Pediatric Surgery | 
| Location | 735 Norman Dr Ste 3, Lebanon, Pennsylvania | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1609136993 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208600000X | Surgery | MT201557 (Pennsylvania) | Secondary | 
| 2086S0120X | Surgery - Pediatric Surgery | MD454180 (Pennsylvania) | Primary | 
| Entity Name | Wellspan Medical Group | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1669770004 PECOS PAC ID: 1951213115 Enrollment ID: O20040220000815 | 
| Entity Name | University Of Penn - Medical Group | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1235527342 PECOS PAC ID: 6204730955 Enrollment ID: O20141111000091 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Elijah Wade Riddle, MD 3400 Spruce St, Philadelphia, PA 19104-4206 Ph: (215) 662-6156 | Elijah Wade Riddle, MD 735 Norman Dr Ste 3, Lebanon, PA 17042-7559 Ph: (717) 270-7908 | 
| Dr. James W Keller, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 735 Norman Dr, Lebanon, PA 17042 Phone: 717-270-7908 Fax: 717-272-1734 | |
| Barbara A. Klatchko, M.D. Surgery Medicare: Medicare Enrolled Practice Location: 402 S 12th St, Lebanon, PA 17042 Phone: 717-274-5200 Fax: 717-274-5440 | |
| Dr. Justin Arthur Snyder, D.O. Surgery Medicare: Accepting Medicare Assignments Practice Location: 735 Norman Dr, Suite 3, Lebanon, PA 17042 Phone: 717-270-7908 Fax: 717-272-1734 | |
| Dr. Charles Dinerstein, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 4th & Walnut Streets, 2nd Floor, Lebanon, PA 17042 Phone: 717-270-3751 Fax: 270-270-3754 | |
| Hilde Jerius, MD Surgery Medicare: Medicare Enrolled Practice Location: 252 S 4th St Fl 2, Lebanon, PA 17042 Phone: 717-270-3751 Fax: 717-270-3754 | |
| Cindy Wu, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 735 Norman Dr Ste 3, Lebanon, PA 17042 Phone: 717-270-7908 Fax: 717-272-1734 | |
| Robert James Meisner, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 252 S 4th St Fl 2, Lebanon, PA 17042 Phone: 717-270-3751 |