Provider Demographics
NPI:1215198841
Name:RICHARD D HAPPEL MD PHD PC
Entity Type:Organization
Organization Name:RICHARD D HAPPEL MD PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:276-228-4860
Mailing Address - Street 1:1150 HOLSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4105
Mailing Address - Country:US
Mailing Address - Phone:276-228-4860
Mailing Address - Fax:
Practice Address - Street 1:1150 HOLSTON ROAD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4105
Practice Address - Country:US
Practice Address - Phone:276-228-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006002501Medicaid
VA006002501Medicaid