Provider Demographics
NPI:1083685911
Name:PROKOPCHAK, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PROKOPCHAK
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 1:2850 KEAGY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7458
Mailing Address - Country:US
Mailing Address - Phone:540-375-9375
Mailing Address - Fax:540-375-9376
Practice Address - Street 1:2850 KEAGY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7458
Practice Address - Country:US
Practice Address - Phone:540-375-9375
Practice Address - Fax:540-375-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047984207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00290780OtherMEDICARE RAILROAD
VA006096891Medicaid
VA006096891Medicaid
E72438Medicare UPIN