1346321767 NPI number — DOUGLAS M RICHTER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346321767 NPI number — DOUGLAS M RICHTER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RICHTER

Provider First Name:

DOUGLAS

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1346321767

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/25/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 COOPER PLZ # 404

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CAMDEN

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08103-1461

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-342-2057

Provider Business Mailing Address Fax Number:

856-968-8348

Provider First Line Business Practice Location Address:

1210 BRACE RD

Provider Second Line Business Practice Location Address:

SUITE 103

Provider Business Practice Location Address City Name:

CHERRY HILL

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08034-3213

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-938-2050

Provider Business Practice Location Address Fax Number:

856-795-2284

Provider Enumeration Date:

10/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  MA068610 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 40762 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 3787255 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 3K6052 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: P00222872 . This is a "RAIL ROAD MEDICAE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1552485 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 857600 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 010003545 02 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7929803 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 60015407 . This is a "HIRIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: P1127233 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 6956385 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 0964119000 . This is a "AMERIHEALTH, HMO, KEYSTONE. IBC" identifier . This identifiers is of the category "OTHER".