Provider Demographics
NPI:1407972664
Name:HUSKEY, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:HUSKEY
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 1:425 E 1ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1480
Mailing Address - Country:US
Mailing Address - Phone:570-387-2060
Mailing Address - Fax:570-387-2316
Practice Address - Street 1:425 E 1ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1480
Practice Address - Country:US
Practice Address - Phone:570-387-2060
Practice Address - Fax:570-387-2316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070043-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF52201Medicare UPIN