Provider Demographics
NPI:1285623645
Name:RICHMAN, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COMMERCIAL ST
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5509
Mailing Address - Country:US
Mailing Address - Phone:781-388-4160
Mailing Address - Fax:781-397-8715
Practice Address - Street 1:109 COMMERCIAL ST
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5509
Practice Address - Country:US
Practice Address - Phone:781-388-4160
Practice Address - Fax:781-397-8715
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47899207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB30165OtherBLUE CROSS LEGACY PROVIDER #
MA0193623Medicaid
MAB30165OtherBLUE CROSS LEGACY PROVIDER #