Provider Demographics
NPI:1922182013
Name:FELLOWS, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:FELLOWS
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-7661
Practice Address - Fax:502-629-5309
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY183772085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000544367OtherANTHEM - KCR
KY3505502OtherPASSPORT ADVTG - KCR
KY50018757OtherPASSPORT - KCR
KY0000230291OtherHUMANA KCR
IN100357970Medicaid
KY64183775Medicaid
KY00533031OtherMEDICARE - KCR
KY92158OtherSIHO - KCR
KY92158OtherSIHO - KCR