Provider Demographics
NPI:1063459667
Name:RICHARD, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 BLUE RIDGE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8002
Mailing Address - Country:US
Mailing Address - Phone:919-859-5650
Mailing Address - Fax:919-859-5695
Practice Address - Street 1:600 NEW WAVERLY PL
Practice Address - Street 2:STE 203
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7404
Practice Address - Country:US
Practice Address - Phone:919-859-5650
Practice Address - Fax:919-859-5695
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0099-00122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891210YMedicaid
NC1210YOtherBCBS
NC2028235AMedicare ID - Type Unspecified
NC1210YOtherBCBS