Provider Demographics
NPI:1164983052
Name:RICHTER, IAN J (DPM)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:J
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MONTAGUE RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9717
Mailing Address - Country:US
Mailing Address - Phone:413-695-9735
Mailing Address - Fax:
Practice Address - Street 1:309 SEASIDE AVE STE 202
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4632
Practice Address - Country:US
Practice Address - Phone:203-876-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1115213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery