Provider Demographics
NPI:1265548085
Name:WIRTZ, RICHARD GREGORY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GREGORY
Last Name:WIRTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 WASHINGTON AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3322
Mailing Address - Country:US
Mailing Address - Phone:410-778-5550
Mailing Address - Fax:410-778-0984
Practice Address - Street 1:818 HIGH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1152
Practice Address - Country:US
Practice Address - Phone:410-778-5550
Practice Address - Fax:410-778-0984
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT4180001OtherBLUE CROSS NAT GROUP #
MD61-45371OtherUBH ID#
MD68134OtherAMERICAN PSYCH SYSTEM #
MD31166OtherJOHNS HOPKINS ID#
MD30956OtherMAMSI/UBH ID#
MD001127OtherVALUE OPTIONS ID#
MDLT86-399909-03OtherBCBS LOCAL GROUP #
MD001127OtherVALUE OPTIONS ID#