Provider Demographics
NPI:1639327356
Name:MARKHAM, RICHARD BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRYAN
Last Name:MARKHAM
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 1:615 N WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2103
Mailing Address - Country:US
Mailing Address - Phone:410-955-9601
Mailing Address - Fax:410-614-8263
Practice Address - Street 1:615 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2103
Practice Address - Country:US
Practice Address - Phone:410-955-9601
Practice Address - Fax:410-614-8263
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19782207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA13989Medicare UPIN