Provider Demographics
NPI:1326012964
Name:DERMAN, RICHARD J (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:DERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HYGELA DRIVE
Mailing Address - Street 2:SUITE 2502
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:DEPT OF OB/GYN, SUITE 1900
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0000
Practice Address - Country:US
Practice Address - Phone:302-733-6510
Practice Address - Fax:302-733-3340
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001030315207V00000X
DEC10008961207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205715303Medicaid
MO263B533AMedicare ID - Type UnspecifiedMEDICARE NUMBER
MO205715303Medicaid
DE145510YOYMedicare PIN