Provider Demographics
NPI:1528010220
Name:DURHAM, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:DURHAM
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 1:150 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924-9037
Mailing Address - Country:US
Mailing Address - Phone:304-799-7400
Mailing Address - Fax:304-799-2276
Practice Address - Street 1:150 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9037
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:304-799-2276
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037025207RP1001X
WV1217207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1528010220OtherHIGHMARK MT STATE BCBS
VA1528010220Medicaid
WV3810005089Medicaid
VA191731OtherANTHEM
WV1528010220OtherHIGHMARK MT STATE BCBS
WV3810005089Medicaid
WV820693Medicare PIN