Provider Demographics
NPI:1336153345
Name:CASWELL, RICHARD BERRY JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BERRY
Last Name:CASWELL
Suffix:JR
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:PO BOX 120590
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-0590
Mailing Address - Country:US
Mailing Address - Phone:757-867-6101
Mailing Address - Fax:757-867-6588
Practice Address - Street 1:1135 CARTHAGE ST
Practice Address - Street 2:CENTRAL CAROLINA HOSPITAL
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-777-7092
Practice Address - Fax:919-774-2399
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC264822085R0202X
NY2249692085R0202X
PAMD071482L2085R0202X
NC2003013402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135P1Medicaid
NCP00395923OtherRAILROAD MEDICARE
NC135P1OtherBCBS
NC135P1OtherBCBS
NC2066837Medicare PIN
NCP00395923OtherRAILROAD MEDICARE