Provider Demographics
NPI:1467420885
Name:SIIRA, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SIIRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9 RICHLAND MEDICAL PARK
Mailing Address - Street 2:SUITE 330
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6859
Mailing Address - Country:US
Mailing Address - Phone:800-290-5309
Mailing Address - Fax:803-434-4354
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-594-1060
Practice Address - Fax:757-594-1066
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101227524207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010157731Medicaid
WV3810007453Medicaid
WV3810007453Medicaid
H19030Medicare UPIN