Provider Demographics
NPI:1417971078
Name:ODERO, RICHARD O (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:ODERO
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 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:T-20
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00613382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC063686300Medicaid
014286D90Medicare ID - Type UnspecifiedDRS. KORSOWER & PION RAD
950MJ665Medicare ID - Type UnspecifiedFREDERICK
014263M14Medicare ID - Type UnspecifiedMONTGOMERY COMMUNITY MAGN
014431C10Medicare ID - Type UnspecifiedCOMMUNITY RADIOLOGY ASSOC
DC063686300Medicaid