Provider Demographics
NPI:1336273184
Name:ALLEN C RICHMOND MD PC
Entity Type:Organization
Organization Name:ALLEN C RICHMOND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-824-1717
Mailing Address - Street 1:3998 RED LION RD
Mailing Address - Street 2:302
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1436
Mailing Address - Country:US
Mailing Address - Phone:215-824-1717
Mailing Address - Fax:215-281-0759
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:302
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-824-1717
Practice Address - Fax:215-281-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029401OtherKEYSTONE MERCY
PA0006169250001Medicaid
PA3341OtherAETNA
PA3430693000OtherKEYSTONE/PERSONAL CHOICE
PA072502OtherBLUE SHIELD
PA19131OtherHEALTH PARTNERS
PADG8566OtherPALMETTO GBA
PAC29004Medicare UPIN
PA0801080001Medicare NSC
PA19131OtherHEALTH PARTNERS