Provider Demographics
NPI:1275522393
Name:PALMER, RICHARD SHANE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SHANE
Last Name:PALMER
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 1:306 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1400
Mailing Address - Country:US
Mailing Address - Phone:540-371-7372
Mailing Address - Fax:540-371-3002
Practice Address - Street 1:306 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1400
Practice Address - Country:US
Practice Address - Phone:540-371-7372
Practice Address - Fax:540-371-3002
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046416Medicaid
VA00V733C13Medicare PIN
VA010046416Medicaid