Provider Demographics
NPI:1639478936
Name:ERIC T. RICHMAN DPM INC
Entity Type:Organization
Organization Name:ERIC T. RICHMAN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-345-8300
Mailing Address - Street 1:470 E MILLTOWN RD
Mailing Address - Street 2:STE B
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1250
Mailing Address - Country:US
Mailing Address - Phone:330-345-8300
Mailing Address - Fax:330-345-6606
Practice Address - Street 1:470 E MILLTOWN RD
Practice Address - Street 2:STE B
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1250
Practice Address - Country:US
Practice Address - Phone:330-345-8300
Practice Address - Fax:330-345-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001879213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0366116Medicaid
OH4826060001Medicare NSC
OH0366116Medicaid