Provider Demographics
NPI:1033206560
Name:RICHMOND UROLOGY, INC.
Entity Type:Organization
Organization Name:RICHMOND UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAFRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-626-0042
Mailing Address - Street 1:1013 CENTER DR
Mailing Address - Street 2:STE. 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3841
Mailing Address - Country:US
Mailing Address - Phone:859-626-0042
Mailing Address - Fax:859-626-0047
Practice Address - Street 1:1013 CENTER DR
Practice Address - Street 2:STE. 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3841
Practice Address - Country:US
Practice Address - Phone:859-626-0042
Practice Address - Fax:859-626-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG29419Medicare UPIN
KY5729730002Medicare NSC