Provider Demographics
NPI:1568447993
Name:RICHARDS, CRAIG W (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 COUNTY RTE 51
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4504
Mailing Address - Country:US
Mailing Address - Phone:518-483-0109
Mailing Address - Fax:518-483-0115
Practice Address - Street 1:380 COUNTY RTE 51
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4504
Practice Address - Country:US
Practice Address - Phone:518-483-0109
Practice Address - Fax:518-483-0115
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213152207R00000X
NY213152-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8810OtherFRANKLIN COUNTY NURSING H
NY01955586Medicaid
NY01995615Medicaid
NYBB7507OtherALICE HYDE MEDICAL CENTER
G98287Medicare UPIN
NYAA0289Medicare ID - Type Unspecified
NYRA8810OtherFRANKLIN COUNTY NURSING H