Provider Demographics
NPI:1609966886
Name:PLOTZKER, RICHARD IVAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:IVAN
Last Name:PLOTZKER
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 1:213 REECEVILLE RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1573
Mailing Address - Country:US
Mailing Address - Phone:610-384-2021
Mailing Address - Fax:610-384-7029
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9402
Practice Address - Country:US
Practice Address - Phone:610-869-2224
Practice Address - Fax:610-869-1481
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014709E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0061181102Medicaid
079050Medicare ID - Type Unspecified
PA0061181102Medicaid