Provider Demographics
NPI:1902038920
Name:RICHARD C. JUANG, M. D. INC.
Entity Type:Organization
Organization Name:RICHARD C. JUANG, M. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:JUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-774-2668
Mailing Address - Street 1:318 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-1743
Mailing Address - Country:US
Mailing Address - Phone:814-774-2668
Mailing Address - Fax:814-864-7090
Practice Address - Street 1:318 MAIN ST E
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-1743
Practice Address - Country:US
Practice Address - Phone:814-774-2668
Practice Address - Fax:814-864-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018134Y261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137199Medicare UPIN