Provider Demographics
NPI:1861485047
Name:SQUIRES, RICHARD STCLAIR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STCLAIR
Last Name:SQUIRES
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 1:198 HALPINE RD
Mailing Address - Street 2:1319
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1661
Mailing Address - Country:US
Mailing Address - Phone:301-984-3124
Mailing Address - Fax:
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-2891
Practice Address - Fax:301-891-2892
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56953207RP1001X
DCMD22067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4432870Medicaid
490840Medicare ID - Type Unspecified
DC4432870Medicaid