Provider Demographics
NPI:1821004698
Name:AGUIRRE, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:67 KENDALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9701
Mailing Address - Country:US
Mailing Address - Phone:315-462-9482
Mailing Address - Fax:315-462-5438
Practice Address - Street 1:5989 BIG TREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4460
Practice Address - Fax:585-346-4463
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY213119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068546Medicaid
NYRA0255Medicare PIN
NY02068546Medicaid