Provider Demographics
NPI:1760472484
Name:SEIFERT, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SEIFERT
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 1:175 W COHAWKIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1145
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-8023
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 12
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3522
Practice Address - Country:US
Practice Address - Phone:610-586-5018
Practice Address - Fax:484-494-0119
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040262207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA060046620OtherPALMETTO RR MEDICARE
PA0719456000OtherBLUE SHIELD PC
PA20960OtherHEALTHPARTNERS
PARS0000532369OtherBLUE SHIELD
PA0010863400006Medicaid
PA48974OtherKEYSTONE MERCY
PA0719456000OtherKEYSTONE
PA2295963OtherAETNA
PA232891927OtherELDERHEALTH
PA232891927OtherBRAVO
PAE71764Medicare UPIN
PA0010863400006Medicaid