Provider Demographics
NPI:1457356016
Name:DECKER, RICHARD LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:DECKER
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 1:3910 CAUGHEY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4041
Mailing Address - Country:US
Mailing Address - Phone:814-877-5401
Mailing Address - Fax:814-877-5400
Practice Address - Street 1:3910 CAUGHEY RD STE 150
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4041
Practice Address - Country:US
Practice Address - Phone:814-877-5401
Practice Address - Fax:814-877-5400
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029593E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080096093OtherRR MEDICARE
PA323588OtherUPMC
PA045299OtherBLUE SHIELD
PA0519398OtherAETNA
NY00026441301OtherUNIVERA
NY01982609OtherNY MEDICAL ASSISTANCE
PA0010434320008Medicaid
PA159806OtherUNISON
OH2221312OtherOH MEDICAL ASSISTANCE
PAP000400OtherGATEWAY
OH2221312OtherOH MEDICAL ASSISTANCE
PA323588OtherUPMC