Provider Demographics
NPI:1073846531
Name:BRUCE RICHMAN D.O. P.C.
Entity type:Organization
Organization Name:BRUCE RICHMAN D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-257-1736
Mailing Address - Street 1:30 S WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1139
Mailing Address - Country:US
Mailing Address - Phone:215-257-1736
Mailing Address - Fax:215-257-2380
Practice Address - Street 1:30 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1139
Practice Address - Country:US
Practice Address - Phone:215-257-1736
Practice Address - Fax:215-257-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006501L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011841450005Medicaid
PA0011841450005Medicaid