Provider Demographics
NPI:1386642007
Name:DUCHARME, RICHARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:DUCHARME
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 1:310 E DEL NORTE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7512
Mailing Address - Country:US
Mailing Address - Phone:719-630-0307
Mailing Address - Fax:719-630-1507
Practice Address - Street 1:310 E DEL NORTE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7512
Practice Address - Country:US
Practice Address - Phone:719-630-0307
Practice Address - Fax:719-630-1507
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01174655Medicaid
CO04011359Medicaid
CO01174655Medicaid
CO26611Medicare PIN