Provider Demographics
NPI:1588647689
Name:SHEPPECK, RICHARD A (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SHEPPECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-877-5600
Mailing Address - Fax:814-877-5601
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-877-5600
Practice Address - Fax:814-877-5601
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036916E208G00000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA770003271OtherRAILROAD MEDICARE
PA041200OtherHIGHMARK BLUE SHIELD
PA007175045Medicaid
PAF82026Medicare UPIN
PA041200OtherHIGHMARK BLUE SHIELD