Provider Demographics
NPI:1568468023
Name:BEHAM, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BEHAM
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 1:2100 W CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-537-5111
Mailing Address - Fax:419-537-5131
Practice Address - Street 1:2100 W CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3834
Practice Address - Country:US
Practice Address - Phone:419-537-5111
Practice Address - Fax:419-537-5131
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055885207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02043OtherPARAMOUNT
OH0852653Medicaid
OH4276722OtherAETNA
OH460003229OtherMEDICARE RR
OH000000203483OtherANTHEM
OH02043OtherPARAMOUNT
OH0852653Medicaid