Provider Demographics
NPI:1528172442
Name:HOLE, RICHARD WITHERSPOON JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WITHERSPOON
Last Name:HOLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:128 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2508
Mailing Address - Country:US
Mailing Address - Phone:610-649-1623
Mailing Address - Fax:610-649-6258
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1107
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-564-5364
Practice Address - Fax:610-649-6258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019032E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8664880548Medicare ID - Type Unspecified