Provider Demographics
NPI:1407997950
Name:EDWIN F. RICHTER, III, MD, LLC
Entity Type:Organization
Organization Name:EDWIN F. RICHTER, III, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:203-316-0610
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:4TH FLOOR SUITE 9
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-316-0610
Mailing Address - Fax:
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:4TH FLOOR SUITE 9
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-316-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004250031Medicaid
CTDG4211Medicare PIN
CTC003376Medicare PIN