Provider Demographics
NPI:1588639165
Name:TEPPER, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:TEPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 GROVE AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-6008
Mailing Address - Country:US
Mailing Address - Phone:215-355-9634
Mailing Address - Fax:215-357-7540
Practice Address - Street 1:729 GROVE AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-6008
Practice Address - Country:US
Practice Address - Phone:215-355-9634
Practice Address - Fax:215-357-7540
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027749E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014786630001Medicaid
PA141344FMUMedicare PIN
PA0014786630001Medicaid