Provider Demographics
NPI:1962745661
Name:RICHARD D KAGEN MD LLC
Entity type:Organization
Organization Name:RICHARD D KAGEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-734-2708
Mailing Address - Street 1:1607 BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2405
Mailing Address - Country:US
Mailing Address - Phone:610-734-2708
Mailing Address - Fax:215-654-0664
Practice Address - Street 1:1607 BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2405
Practice Address - Country:US
Practice Address - Phone:610-734-2708
Practice Address - Fax:215-654-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025223E282N00000X, 310400000X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009240570001Medicaid
PA0009240570001Medicaid