Provider Demographics
NPI:1801865670
Name:RICHARD, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NEIL
Other - Middle Name:E
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:444 N CLEVELAND AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8389
Mailing Address - Country:US
Mailing Address - Phone:614-899-2700
Mailing Address - Fax:614-823-5656
Practice Address - Street 1:444 N CLEVELAND AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8389
Practice Address - Country:US
Practice Address - Phone:614-899-2700
Practice Address - Fax:614-823-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0137060Medicaid
OHH401710Medicare PIN
OH0103052OtherUNITED HEALTHCARE ID NUMB
OH000000106955OtherANTHEM PIN NUMBER
OH0137060Medicaid