Provider Demographics
NPI:1790730471
Name:NAIMARK, RICHARD MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MATTHEW
Last Name:NAIMARK
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 1:16 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2950
Mailing Address - Country:US
Mailing Address - Phone:603-749-4462
Mailing Address - Fax:603-749-2475
Practice Address - Street 1:16 FIFTH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2950
Practice Address - Country:US
Practice Address - Phone:603-749-4462
Practice Address - Fax:603-749-2475
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200771Medicaid
NVRE4747Medicare ID - Type UnspecifiedMEDICARE
F17618Medicare UPIN