Provider Demographics
NPI:1023126158
Name:OLAUGHLIN, RICHARD LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:OLAUGHLIN
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 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE.1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:
Practice Address - Street 1:72 W JIMMIE LEEDS RD
Practice Address - Street 2:STE.1100
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9406
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049142002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00231506OtherRAILROAD MEDICARE
NJ5018102Medicaid
NJP00758345OtherRAILROAD MEDICARE
NJP00847816OtherRAILROAD MEDICARE
NJ695381ZEKDMedicare PIN
NJP00231506OtherRAILROAD MEDICARE
NJP00847816OtherRAILROAD MEDICARE
NJ695381AMLMedicare PIN