Provider Demographics
NPI:1306959812
Name:YAN, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:YAN
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 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:700 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1019
Practice Address - Country:US
Practice Address - Phone:518-372-5637
Practice Address - Fax:518-355-3996
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10031234OtherCDPHP
NY200182OtherSENIOR WHOLE HEALTH
NY070124000080OtherFIDELIS
NY26256OtherMVP
NY01160232Medicaid
NY000493509001OtherBSNENY
NY47371OtherGHI/HMO
NY7845588OtherAETNA
NY571281OtherEMPIRE BC
NY47371OtherGHI/HMO