Provider Demographics
NPI:1063605632
Name:RICHARD H ISRAEL PHD PA
Entity type:Organization
Organization Name:RICHARD H ISRAEL PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-589-3277
Mailing Address - Street 1:2101 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4053
Mailing Address - Country:US
Mailing Address - Phone:301-589-3277
Mailing Address - Fax:301-589-3632
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 211
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-589-3277
Practice Address - Fax:301-589-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R23587231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADR5311OtherRAILROAD MEDICARE
DC188958OtherMEDICARE
MDL050RHOtherCAREFIRST
DC1199 0001OtherCAREFIRST
GADR5311OtherRAILROAD MEDICARE