Provider Demographics
NPI:1992750582
Name:GEWANTER, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GEWANTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N VILLAGE AVE
Mailing Address - Street 2:MEMORIAL SLOAN-KETTERING CANCER CENTER
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1000
Mailing Address - Country:US
Mailing Address - Phone:516-256-3600
Mailing Address - Fax:516-256-1644
Practice Address - Street 1:1000 N VILLAGE AVE
Practice Address - Street 2:MEMORIAL SLOAN-KETTERING CANCER CENTER
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1000
Practice Address - Country:US
Practice Address - Phone:516-256-3600
Practice Address - Fax:516-256-1644
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209945-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02375588Medicaid
NY2199E1Medicare ID - Type Unspecified
NY02375588Medicaid