Provider Demographics
NPI:1851459044
Name:SACKS, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:SACKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5225 POOKS HILL RD
Mailing Address - Street 2:SUITE 111 SOUTH
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2052
Mailing Address - Country:US
Mailing Address - Phone:301-493-5335
Mailing Address - Fax:301-493-2743
Practice Address - Street 1:5225 POOKS HILL RD
Practice Address - Street 2:SUITE 111 SOUTH
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2052
Practice Address - Country:US
Practice Address - Phone:301-493-5335
Practice Address - Fax:301-493-2743
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD212182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC28748Medicare UPIN