Provider Demographics
NPI:1619922622
Name:WACHS, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WACHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2555 MERIDIAN BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6670
Mailing Address - Country:US
Mailing Address - Phone:615-665-7115
Mailing Address - Fax:615-665-8776
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:STE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4495
Practice Address - Country:US
Practice Address - Phone:505-883-2574
Practice Address - Fax:505-265-4033
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA075145207KA0200X
NMMD2016-0029207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJL13572Medicare UPIN