Provider Demographics
NPI:1033261318
Name:ALLEY, RICHARD ABBAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ABBAS
Last Name:ALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:166 HANOVER ST
Mailing Address - Street 2:203
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3549
Mailing Address - Country:US
Mailing Address - Phone:570-825-8780
Mailing Address - Fax:570-825-8785
Practice Address - Street 1:166 HANOVER ST
Practice Address - Street 2:203
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3549
Practice Address - Country:US
Practice Address - Phone:570-825-8780
Practice Address - Fax:570-825-8785
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027600L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA00595398Medicaid
C27138Medicare UPIN
PAMA00595398Medicaid