Provider Demographics
NPI:1881634046
Name:PALMER, RICHARD ROY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROY
Last Name:PALMER
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 1:9055 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1301
Mailing Address - Country:US
Mailing Address - Phone:301-330-0400
Mailing Address - Fax:301-948-4333
Practice Address - Street 1:9055 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-330-0400
Practice Address - Fax:301-948-4333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00140742084P0800X
VA01010247032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC23070011OtherBLUE CROSS BLUE SHIELD
MD249536OtherUNITED HEALTHCARE-MAMSI
MD249536OtherUNITED HEALTHCARE-MAMSI
015692M32Medicare ID - Type Unspecified
C88341Medicare UPIN