Provider Demographics
NPI:1003094020
Name:RICHARD NIEMEYER, MD, INC.
Entity Type:Organization
Organization Name:RICHARD NIEMEYER, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NIEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-363-3121
Mailing Address - Street 1:17709 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5604
Mailing Address - Country:US
Mailing Address - Phone:818-363-3121
Mailing Address - Fax:818-366-1728
Practice Address - Street 1:17709 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5604
Practice Address - Country:US
Practice Address - Phone:818-363-3121
Practice Address - Fax:818-366-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28871208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28871OtherPRESIDENTS MED LICENSE