Provider Demographics
NPI:1023018298
Name:TRAISTER, RICHARD GRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GRAD
Last Name:TRAISTER
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 1:6 SUMMERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-1847
Mailing Address - Country:US
Mailing Address - Phone:978-363-2484
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-463-7770
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0116009Medicaid
MAA53982Medicare UPIN
MA0116009Medicaid