Provider Demographics
NPI:1740414853
Name:WEISKOPF, RICHARD WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WALTER
Last Name:WEISKOPF
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 1:5031 ONONDAGA RD.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1403
Mailing Address - Country:US
Mailing Address - Phone:315-488-2140
Mailing Address - Fax:
Practice Address - Street 1:259 EAST ONONDAGA ST.
Practice Address - Street 2:AMAUS HEALTH SERVICES AT CATHEDRAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-424-1911
Practice Address - Fax:315-424-1911
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079726-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine