1629048103 NPI number — RICHARD NORMAN MD

Table of content: RICHARD NORMAN MD (NPI 1629048103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629048103 NPI number — RICHARD NORMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORMAN
Provider First Name:
RICHARD
Provider Middle Name:
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:
NORMAN
Provider Other First Name:
RICHARD
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629048103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05444-0102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-644-5114
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05444-9810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-644-5114
Provider Business Practice Location Address Fax Number:
802-644-5573
Provider Enumeration Date:
01/25/2006

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: 207R00000X , with the licence number:  0420005840 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0002371 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042-0005840 . This is a "STATE LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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