Provider Demographics
NPI:1619941663
Name:RAUCH, RICHARD LUTHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LUTHER
Last Name:RAUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HEALTH CARE LN.
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8896
Mailing Address - Country:US
Mailing Address - Phone:304-267-5544
Mailing Address - Fax:304-267-5545
Practice Address - Street 1:123 HEALTH CARE LN.
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-5544
Practice Address - Fax:304-267-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099866000Medicaid
MD224745OtherMAMSI
WV000625002OtherMOUNTAIN STATE BCBS
WV4180120001Medicare NSC
RA0771171Medicare ID - Type Unspecified
WV4180120002Medicare NSC
WV000625002OtherMOUNTAIN STATE BCBS