Provider Demographics
NPI:1134149271
Name:DOWELL, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3100
Practice Address - Country:US
Practice Address - Phone:570-321-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005489L103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50038517OtherCAPITAL BLUE CROSS
PA118438714OtherDEPARTMENT OF LABOR
PA743597OtherBLUE SHIELD
PA386433OtherVALUE OPTIONS
PA20042471OtherAMERIHEALTH
PA743597Medicare ID - Type Unspecified
PA50038517OtherCAPITAL BLUE CROSS
PAP00195890OtherRAILROAD MEDICARE
PA50038517OtherCAPITAL BLUE CROSS
PA14075360010Medicaid