Provider Demographics
NPI:1568447613
Name:WYATT, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2178
Mailing Address - Country:US
Mailing Address - Phone:413-549-7400
Mailing Address - Fax:413-549-7402
Practice Address - Street 1:29B COTTAGE ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2172
Practice Address - Country:US
Practice Address - Phone:413-549-7400
Practice Address - Fax:413-549-7402
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000020255OtherBMC
MA000183947610OtherUNITED HEALTHCARE
MA010550144OtherCONSOLIDATED
MA010550144OtherTRICARE
MA155828OtherTUFTS
MAJ19454OtherBCBSMA
MA010550144OtherNORTHEAST HEALTHCARE ALLI
MA010550144OtherPLAN VISTA
MA10550144OtherCONNECTICARE
MA7011791-005OtherCIGNA
MA401219OtherHARVARD PILGRIM
MA010550144OtherGREAT-WEST
MA010550144OtherPHCS
MA10550144OtherPIONEER HEALTH NETWORK
MA5108024OtherAETNA
MA010550144OtherNORTH AMERICAN PREFERRED
MA010550144OtherNORTHEAST HEALTH DIRECT
MA29546OtherHEALTH NEW ENGLAND
MA10550144OtherPIONEER HEALTH NETWORK
MA000183947610OtherUNITED HEALTHCARE