Provider Demographics
NPI:1073628533
Name:CAVENDER, RICHARD K (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:CAVENDER
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 1:615 COPELAND MILL RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8904
Mailing Address - Country:US
Mailing Address - Phone:614-939-2308
Mailing Address - Fax:
Practice Address - Street 1:615 COPELAND MILL RD STE 2D
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-939-2308
Practice Address - Fax:614-939-2309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066429CTR207R00000X
CAG89337208D00000X
OH35-066429208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776709Medicare PIN
OHF96529Medicare UPIN