Provider Demographics
NPI:1023126943
Name:RICHARD, IRENE H (MD)
Entity type:Individual
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First Name:IRENE
Middle Name:H
Last Name:RICHARD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278984
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-341-7500
Mailing Address - Fax:585-341-7510
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG C, SUITE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:585-341-7510
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-07-03
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Provider Licenses
StateLicense IDTaxonomies
NY1982212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01613372Medicaid
NY11445EMedicare PIN
NYG15657Medicare UPIN