Provider Demographics
NPI:1306839774
Name:GUALTIERI, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:GUALTIERI
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 1:201 SIVLEY ROAD, SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5177
Mailing Address - Country:US
Mailing Address - Phone:256-265-1822
Mailing Address - Fax:256-265-1825
Practice Address - Street 1:201 SIVLEY ROAD, SW
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5177
Practice Address - Country:US
Practice Address - Phone:256-265-1822
Practice Address - Fax:256-265-1825
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-12-12
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
AL11446207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009945795Medicaid
AL009945795Medicaid
ALC73415Medicare UPIN