Provider Demographics
NPI:1457448847
Name:FROST, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:FROST
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 1:107 SALMON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5730
Mailing Address - Country:US
Mailing Address - Phone:518-563-5342
Mailing Address - Fax:
Practice Address - Street 1:107 SALMON RIVER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5730
Practice Address - Country:US
Practice Address - Phone:518-563-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12989901207R00000X
NY129899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000490426001OtherBS OF NENY
NY114406OtherVALUE OPTIONS
NY00470764Medicaid
NYP010129899OtherEXCELLUS/UTICA WATERTOWN
NY110156754OtherRAILROAD MEDICARE
NY141338471OtherGHI
NYRF077E2410OtherEMPIRE BC/BS
NY141338471OtherFIDELIS
NY562007OtherMVP
NY7420685OtherAETNA
C49539Medicare UPIN
NYP010129899OtherEXCELLUS/UTICA WATERTOWN