Provider Demographics
NPI:1689780108
Name:FOOTER, RICHARD NEIL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEIL
Last Name:FOOTER
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 1:8017 SUMMER MILL CT
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2962
Mailing Address - Country:US
Mailing Address - Phone:301-320-6303
Mailing Address - Fax:301-215-4561
Practice Address - Street 1:4808 MOORLAND LN
Practice Address - Street 2:SUITE 103
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6110
Practice Address - Country:US
Practice Address - Phone:301-215-7778
Practice Address - Fax:301-215-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027550174400000X
DCMD14379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428361900Medicaid
482910OtherMEDICARE
482910OtherMEDICARE