Provider Demographics
NPI:1003811472
Name:CAIN, RICHARD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:CAIN
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 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:606 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1730
Practice Address - Country:US
Practice Address - Phone:304-273-1033
Practice Address - Fax:304-273-1034
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075378207Q00000X
WV15792207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957166Medicaid
WV0042198000Medicaid
OH000000228470OtherANTHEM
OH000000699779OtherANTHEM
0751035Medicare ID - Type Unspecified
WV0042198000Medicaid
OH0957166Medicaid
OH000000228470OtherANTHEM