Provider Demographics
NPI:1295791382
Name:CLOSE, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:CLOSE
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 1:601 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1443
Mailing Address - Country:US
Mailing Address - Phone:610-375-4567
Mailing Address - Fax:610-685-8801
Practice Address - Street 1:601 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1443
Practice Address - Country:US
Practice Address - Phone:610-375-4567
Practice Address - Fax:610-685-8801
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014713E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116567600OtherUS DEPT OF LABOR
PA093544R1XOtherMEDICARE ID
PA093544OtherHIGHMARK BLUE SHIELD
PA5554OtherHEALTH AMERICA
PA0007408280001Medicaid
PA01530101OtherCAPITAL B;UE CROSS
PA140001335OtherMEDICARE RAILROAD
PA3281544OtherAETNA HMO
PA5431128OtherAETNA PPO
PA01530101OtherCAPITAL B;UE CROSS
PAC29669Medicare PIN