Provider Demographics
NPI:1164937868
Name:QUARTERMAIN, RICHARD FREDERICK (HIS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:QUARTERMAIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRUSH ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3344
Mailing Address - Country:US
Mailing Address - Phone:402-371-0612
Mailing Address - Fax:
Practice Address - Street 1:1496 STILL MEADOW BLVD STE B124
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7511
Practice Address - Country:US
Practice Address - Phone:410-219-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02791237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist