Provider Demographics
NPI:1285631754
Name:DAMEWOOD, RICHARD BRYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRYANT
Last Name:DAMEWOOD
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6110
Mailing Address - Fax:717-851-1999
Practice Address - Street 1:25 MONUMENT ROAD
Practice Address - Street 2:SUITE #120
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-851-6110
Practice Address - Fax:717-851-1999
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028146208600000X
PAMD436419208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD340521400Medicaid
PA20090503OtherAMERIHEALTH MERCY-WMG
PA268842OtherUNISON-WMG
PA102291062Medicaid
PA1581781OtherGATEWAY
MD208475OtherCAREFIRST MD BCBS
PA2099253OtherHIGHMARK BLUE SHIELD
C48840Medicare UPIN
PA151936FLTMedicare PIN
MD340521400Medicaid
L346Medicare ID - Type Unspecified