1811970296 NPI number — DR. VICTOR R RISCH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811970296 NPI number — DR. VICTOR R RISCH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RISCH

Provider First Name:

VICTOR

Provider Middle Name:

R

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

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:

1811970296

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/23/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1020A E BOAL AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOALSBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

16827-1509

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

814-237-8627

Provider Business Mailing Address Fax Number:

814-238-0083

Provider First Line Business Practice Location Address:

CEDAR CREST I78

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALLENTOWN

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

18105

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-402-0700

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  MD025945E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01222901 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 016914 . This is a "BCBS PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P2821009 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 300018185 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 34109 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 20010565 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0011264370007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0016914 . This is a "KEYSTONE HEALTHPLAN CENTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0071398000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 133200 . This is a "MEDPLUS/THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 6123250002 . This is a "CIGNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".