Provider Demographics
NPI:1407550262
Name:BOKOTH, RICHARD K I
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BOKOTH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 METZEROTT RD APT 1727
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3452
Mailing Address - Country:US
Mailing Address - Phone:240-704-2765
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT 1727
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3452
Practice Address - Country:US
Practice Address - Phone:204-704-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health