Provider Demographics
NPI:1346321767
Name:RICHTER, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:RICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 COOPER PLZ # 404
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-2057
Mailing Address - Fax:856-968-8348
Practice Address - Street 1:1210 BRACE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3213
Practice Address - Country:US
Practice Address - Phone:856-938-2050
Practice Address - Fax:856-795-2284
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA068610207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
40762OtherUNIVERSITY HEALTH PLAN
3787255OtherAETNA
3K6052OtherHEALTHNET
P00222872OtherRAIL ROAD MEDICAE
1552485OtherUNITED HEALTH CARE
857600OtherAMERIHEALTH PPO
010003545 02OtherAMERICHOICE
NJ7929803Medicaid
60015407OtherHIRIZON NJ HEALTH
P1127233OtherOXFORD HEALTH PLAN
6956385OtherCIGNA
0964119000OtherAMERIHEALTH, HMO, KEYSTONE. IBC
1552485OtherUNITED HEALTH CARE
G25065Medicare UPIN