Provider Demographics
NPI:1770663791
Name:JONES, RICHARD W (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:JONES
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 1:2524 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143
Mailing Address - Country:US
Mailing Address - Phone:518-756-7390
Mailing Address - Fax:518-756-8030
Practice Address - Street 1:2524 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143
Practice Address - Country:US
Practice Address - Phone:518-756-7390
Practice Address - Fax:518-756-8030
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000494454005OtherBSNENY
NY7299168OtherAETNA
NY01410282Medicaid
NY10031231OtherCDPHP
NY200299OtherSENIOR WHOLE HEALTH
NY5538P1OtherEMPIRE BC
NY071030000106OtherFIDELIS
NY119672OtherGHI/HMO
NY08340OtherMVP
NY7299168OtherAETNA
NY01410282Medicaid