Provider Demographics
NPI:1972668374
Name:RICHARD C KAISER MD LLC
Entity type:Organization
Organization Name:RICHARD C KAISER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-778-0017
Mailing Address - Street 1:11 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1136
Mailing Address - Country:US
Mailing Address - Phone:781-778-0017
Mailing Address - Fax:978-287-6199
Practice Address - Street 1:41 NORTH RD STE 204
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-778-0017
Practice Address - Fax:781-778-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21717Medicaid
MA9745190Medicaid