Provider Demographics
NPI:1255303228
Name:PLOTZKER, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PLOTZKER
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 1:501 S 54TH ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-748-9872
Mailing Address - Fax:215-748-9869
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:SUITE 126
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9872
Practice Address - Fax:215-748-9869
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002248207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE604814Medicare PIN