Provider Demographics
NPI:1629048103
Name:NORMAN, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-0102
Mailing Address - Country:US
Mailing Address - Phone:802-644-5114
Mailing Address - Fax:
Practice Address - Street 1:272 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444-9810
Practice Address - Country:US
Practice Address - Phone:802-644-5114
Practice Address - Fax:802-644-5573
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002371Medicaid
VT042-0005840OtherSTATE LICENSE
VT0002371Medicaid
VTC65220Medicare UPIN