Provider Demographics
NPI:1306823331
Name:POHL, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:POHL
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:PO BOX 682217
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-2217
Mailing Address - Country:US
Mailing Address - Phone:617-335-0941
Mailing Address - Fax:
Practice Address - Street 1:845 E 4800 S STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5041
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:801-265-9604
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA345372084P0800X, 2084P0804X
UT9593487-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM08721OtherBLUE CROSS BLUE SHIELD
MA034537OtherTUFTS HEALTH PLAN
MAM08721OtherBLUE CROSS BLUE SHIELD
MA034537OtherTUFTS HEALTH PLAN