Provider Demographics
NPI:1417215393
Name:LAMKIN, RICHARD DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVID
Last Name:LAMKIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LOCUST AVE
Mailing Address - Street 2:WCMG/HEMATOLOGY-ONCOLOGY
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6148
Mailing Address - Country:US
Mailing Address - Phone:203-739-7029
Mailing Address - Fax:203-739-8455
Practice Address - Street 1:95 LOCUST AVE
Practice Address - Street 2:WCMG/HEMATOLOGY-ONCOLOGY
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6148
Practice Address - Country:US
Practice Address - Phone:203-739-7029
Practice Address - Fax:203-739-8455
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1101806363A00000X
CT003738363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant