Provider Demographics
NPI:1609875913
Name:NAGLE, RICHARD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM
Last Name:NAGLE
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 1:717 STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6000
Practice Address - Fax:814-877-6149
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028963E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010746260015Medicaid
PA124311OtherBLUE SHIELD
PA147546OtherUNISON - IMAGING CENTER
NY00025816801OtherUNIVERA
PA300104087OtherRR MEDICARE
PA219069OtherUPMC
PA3364045OtherAETNA
OH666328OtherOH MEDICAL ASSISTANCE
NY00940161OtherNY MEDICAL ASSISTANCE
WV1068842OtherWEST VIRGINIA WORK COMP
PA086601OtherUNISON - HAMOT RADIOLOGY
PA1512635OtherGATEWAY
NY00025816801OtherUNIVERA
PA219069OtherUPMC