1235198714 NPI number — RICHARD R STOUT MD

Table of content: RICHARD R STOUT MD (NPI 1235198714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235198714 NPI number — RICHARD R STOUT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOUT
Provider First Name:
RICHARD
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1235198714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 MASON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14456-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-789-3937
Provider Business Mailing Address Fax Number:
315-789-2616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MASON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14456-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-789-3937
Provider Business Practice Location Address Fax Number:
315-789-2616
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  225735 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 225735 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201178047 . This is a "GROUP HEALTH INCORPORATED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4086529 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7700447 . This is a "MVP SELECT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010225735 . This is a "EXCELLUS BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010225735 . This is a "MONROE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "UNITED HEALTH CARE EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "SIDNEY HILLMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "WORKERS COMPENSATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82636 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141751CR . This is a "PREFERRED CARE OPTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00141516 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141751CR . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178047 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7702618 . This is a "DOCTORS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010225735 . This is a "HEALTHY NY" identifier . This identifiers is of the category "OTHER".




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