Provider Demographics
NPI:1760421754
Name:KAISER, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1136
Mailing Address - Country:US
Mailing Address - Phone:978-371-4427
Mailing Address - Fax:781-275-4511
Practice Address - Street 1:97 LOWELL RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1733
Practice Address - Country:US
Practice Address - Phone:978-610-6764
Practice Address - Fax:978-287-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA771442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3113655Medicaid
MA3113655Medicaid