Provider Demographics
NPI:1972618031
Name:HUSBAND, RICHARD T (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:HUSBAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W WELLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1411
Mailing Address - Country:US
Mailing Address - Phone:570-662-1945
Mailing Address - Fax:
Practice Address - Street 1:45 MUD CREEK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-9529
Practice Address - Country:US
Practice Address - Phone:570-297-3746
Practice Address - Fax:570-297-5127
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005056-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03512232Medicaid
PA000953264Medicaid
NY03512232Medicaid
PA090570YHLYMedicare PIN