Provider Demographics
NPI:1629076179
Name:ADLER, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:ADLER
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 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6207
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:1427 CLARKVIEW RD
Practice Address - Street 2:SUITE 300E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2100
Practice Address - Country:US
Practice Address - Phone:410-296-0414
Practice Address - Fax:410-821-9495
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404844000Medicaid
MDI-07087Medicare UPIN
MDS049522Medicare ID - Type Unspecified