Provider Demographics
NPI:1215920400
Name:KATZ, RICHARD ERIC (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 ROUTE 611
Mailing Address - Street 2:SUITE 22
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7824
Mailing Address - Country:US
Mailing Address - Phone:570-629-1700
Mailing Address - Fax:
Practice Address - Street 1:3180 ROUTE 611
Practice Address - Street 2:SUITE 22
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7824
Practice Address - Country:US
Practice Address - Phone:570-629-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006295L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012079470003Medicaid
PA0012079470003Medicaid
603708Medicare ID - Type Unspecified