Provider Demographics
NPI:1780850362
Name:RICHARD UNDERWOOD DO INC
Entity Type:Organization
Organization Name:RICHARD UNDERWOOD DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-865-9502
Mailing Address - Street 1:495 COOPER RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:614-865-9502
Mailing Address - Fax:614-865-9508
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:SUITE 218
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8710
Practice Address - Country:US
Practice Address - Phone:614-865-9502
Practice Address - Fax:614-865-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9341161Medicare UPIN