Provider Demographics
NPI:1700194537
Name:H RICHARD CASDORPH MD INC
Entity Type:Organization
Organization Name:H RICHARD CASDORPH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CASDORPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-597-8716
Mailing Address - Street 1:1703 TERMINO AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2124
Mailing Address - Country:US
Mailing Address - Phone:562-597-8716
Mailing Address - Fax:
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2124
Practice Address - Country:US
Practice Address - Phone:562-597-8716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC23386OtherMEDICARE PTAN