Provider Demographics
NPI:1972668374
Name:RICHARD C KAISER MD LLC
Entity Type:Organization
Organization Name:RICHARD C KAISER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-610-6764
Mailing Address - Street 1:11 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1136
Mailing Address - Country:US
Mailing Address - Phone:978-371-4427
Mailing Address - Fax:781-275-4511
Practice Address - Street 1:97 LOWELL RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1733
Practice Address - Country:US
Practice Address - Phone:978-610-6764
Practice Address - Fax:978-287-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9745190Medicaid
MAM21717Medicare UPIN