Provider Demographics
NPI:1609978329
Name:RICHTER, MICHAEL LLOYD (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LLOYD
Last Name:RICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:L
Other - Last Name:RICHTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:92 15 63RD DRIVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-897-6223
Mailing Address - Fax:718-897-6215
Practice Address - Street 1:92 15 63RD DRIVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-897-6223
Practice Address - Fax:718-897-6215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188671207RA0401X
NY049755208000000X
NY142859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00499Medicare PIN
F31927Medicare UPIN