Provider Demographics
NPI:1184651598
Name:MAGILL, RICHARD MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARTIN
Last Name:MAGILL
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 1:19 BRADHURST AVENUE
Mailing Address - Street 2:SUITE 1300N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-789-2700
Mailing Address - Fax:914-789-2744
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1300N
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-789-2700
Practice Address - Fax:914-789-2744
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014388755Medicaid
NY014388755Medicaid
NY83H831Medicare PIN