Provider Demographics
NPI:1205811502
Name:RICHENSTEIN, VICTOR B (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:B
Last Name:RICHENSTEIN
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 1:44 CLUB RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2422
Mailing Address - Country:US
Mailing Address - Phone:541-343-2569
Mailing Address - Fax:541-343-0058
Practice Address - Street 1:44 CLUB RD
Practice Address - Street 2:SUITE 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2422
Practice Address - Country:US
Practice Address - Phone:541-343-2569
Practice Address - Fax:541-343-0058
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19262MD2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E96053Medicare UPIN
OR106027Medicare ID - Type Unspecified