Provider Demographics
NPI:1518935485
Name:PFAU, RICHARD GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GORDON
Last Name:PFAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7671 QUARTERFIELD ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-766-0111
Mailing Address - Fax:410-582-9155
Practice Address - Street 1:810 LANDMARK DR STE 117-119
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4987
Practice Address - Country:US
Practice Address - Phone:410-766-0111
Practice Address - Fax:410-582-9155
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029194174400000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD339061603Medicaid
MDI287Medicare PIN
MDD74534Medicare UPIN
MD339061603Medicaid
D74534Medicare UPIN