Provider Demographics
NPI:1275589442
Name:OBRIEN, RICHARD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0100
Mailing Address - Country:US
Mailing Address - Phone:518-773-5690
Mailing Address - Fax:518-773-5620
Practice Address - Street 1:99 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-0100
Practice Address - Country:US
Practice Address - Phone:518-773-5690
Practice Address - Fax:518-773-5620
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02221341Medicaid
NY3012085OtherMVP HEALTH PLAN
NY000921689002OtherBSH NE NY
NY100766990OtherCDPHP
NY02221341Medicaid
NY100766990OtherCDPHP