Provider Demographics
NPI:1578661112
Name:HANDAL, RICHARD GILBERT (MD PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GILBERT
Last Name:HANDAL
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4793 N CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7937
Mailing Address - Country:US
Mailing Address - Phone:561-969-7811
Mailing Address - Fax:
Practice Address - Street 1:4793 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7937
Practice Address - Country:US
Practice Address - Phone:561-969-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0063105207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372547200Medicaid
FL372547200Medicaid
FL18503Medicare ID - Type Unspecified