Provider Demographics
NPI:1033238704
Name:SUMMERMATTER, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:SUMMERMATTER
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 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:
Practice Address - Street 1:NORTH COUNTRY WOMEN'S HEALTH
Practice Address - Street 2:15 HOSPITAL DR
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662
Practice Address - Country:US
Practice Address - Phone:315-769-4638
Practice Address - Fax:315-842-3099
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16612207V00000X
NY153116207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842759Medicaid
NH30205433Medicaid
ME431955299Medicaid
MENX3951Medicare PIN
MEME1581Medicare PIN
ME431955299Medicaid