Provider Demographics
NPI:1578550638
Name:MEDLEY, RICHARD N III (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
Last Name:MEDLEY
Suffix:III
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 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3748
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4173
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-282-3899
Practice Address - Fax:812-282-4173
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043575A208800000X
KY29716208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200122970Medicaid
KY340013659OtherRR MCR
KY64297161Medicaid
INP00229858OtherRR MCR
IN122620FMedicare ID - Type Unspecified