Provider Demographics
NPI:1356360762
Name:SPOSITO, RICHARD SY (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SY
Last Name:SPOSITO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PLACE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:7686 WEST RIDGE RD.
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415
Practice Address - Country:US
Practice Address - Phone:814-474-2654
Practice Address - Fax:814-474-2656
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010284L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018505010005Medicaid
PA050097US8Medicare PIN
PA0018505010003Medicaid