Provider Demographics
NPI:1437112729
Name:ROEDER, V. RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:V.
Middle Name:RICHARD
Last Name:ROEDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-0220
Mailing Address - Country:US
Mailing Address - Phone:610-892-0800
Mailing Address - Fax:
Practice Address - Street 1:211 N MONROE ST
Practice Address - Street 2:2ND. FL.
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3019
Practice Address - Country:US
Practice Address - Phone:610-891-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003327-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065791Medicare ID - Type Unspecified