Provider Demographics
NPI:1649207762
Name:SHUMWAY, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:SHUMWAY
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 1:94 WOODLAND STREET
Mailing Address - Street 2:DEPT OF RADIATION ONCOLOGY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4568
Mailing Address - Fax:860-714-8019
Practice Address - Street 1:94 WOODLAND ST
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1217
Practice Address - Country:US
Practice Address - Phone:860-714-4568
Practice Address - Fax:860-714-8019
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0314652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1314568Medicaid
CTD99761Medicare UPIN
CT1314568Medicaid