Provider Demographics
NPI:1255324604
Name:KUNTZ, RICHARD LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 724195
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-1195
Mailing Address - Country:US
Mailing Address - Phone:860-282-4137
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:111 FOUNDERS PLZ
Practice Address - Street 2:#300 C/O IPMS
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3212
Practice Address - Country:US
Practice Address - Phone:860-282-4137
Practice Address - Fax:860-282-0170
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035971207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359711Medicaid
CT050001297Medicare ID - Type Unspecified
CT001359711Medicaid