Individual provider Active NPI

Elijah Wade Riddle, M.D.

  • Surgery Physician
  • Wynnewood, PA
National Provider Identifier
1609136993
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD454180 Issued in PA
Practice address
100 E Lancaster Ave
Suite 275 Lankenau Med Sci BLDG
Wynnewood, PA 19096-3450
Phone
(610) 642-1908
Fax
(610) 642-6808
NPI assigned
May 21, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD454180 PA Primary
Pediatric Surgery Physician 2086S0120X MD454180 PA

Addresses

Primary practice location

100 E Lancaster Ave
Suite 275 Lankenau Med Sci BLDG
Wynnewood, PA 19096-3450

Mailing address

3803 W Chester Pike Ste 160
Newtown Square, PA 19073-2336

Other practice location 1

735 Norman Dr Ste 3
Lebanon, PA 17042-7559
Phone (717) 270-7908

Other practice location 2

3401 Civic Center Blvd
Division of Surgery
Philadelphia, PA 19104-4319
Phone (215) 662-6156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191009000483 PA Practitioner - General Surgery 3577853324 Reassigns benefits to 3 organizations
I20230110000470 NJ Practitioner - General Surgery 3577853324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Washington University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Wynewood, PA 19096-3450
Phone (610) 642-1908

Hospital & facility affiliations

  • Main Line Health Home Care & Hospice - Home Health Home health agency, Radnor, PA, CCN 397012
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD454180PAMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Pediatric Surgery CurrentSince Oct 25, 2019 Accepting new patients
University Physician Associates of New Jersey Inc CurrentSince Jan 9, 2023 Accepting new patients
Wellspan Medical Group CurrentSince Oct 25, 2019 Accepting new patients
University Physician Associates of New Jersey Inc Surgery CurrentSince Jan 9, 2023 Accepting new patients
Main Line Healthcare Surgery CurrentSince Oct 16, 2025 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Wellspan Medical Group Current Accepting new patients
University of Penn-Medical Group Surgery CurrentSince Feb 1, 2020 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 1, 2020 Accepting new patients
Main Line Hospitals, Inc. Past Accepting new patients
University Hospital Past Accepting new patients

Locations

30 Bergen St
#12
Newark, NJ 07107
Phone (973) 972-0037

30 Bergen St
Rm 1205
Newark, NJ 07107
Phone (973) 972-0037

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

735 Norman Dr
Ste 3
Lebanon, PA 17042
Phone (717) 270-7908

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

100 E Lancaster Ave
Ste 275
Wynnewood, PA 19096
Phone (484) 476-8390

100 E Lancaster Ave
#275
Wynnewood, PA 19096
Phone (215) 622-3743

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1609136993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "address_2": "SUITE 275 LANKENAU MED SCI BLDG",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "610-642-1908",
            "fax_number": "610-642-6808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "735 Norman Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427559",
            "country_code": "US",
            "telephone_number": "717-270-7908",
            "fax_number": "717-272-1734",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 Civic Center Blvd",
            "address_2": "Division of Surgery",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044319",
            "country_code": "US",
            "telephone_number": "215-662-6156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "ELIJAH",
        "middle_name": "WADE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD454180",
            "primary": true
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "PA",
            "license": "MD454180",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.