Provider Demographics
NPI:1457398042
Name:MCGRATH, RICHARD W (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:MCGRATH
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 1:506 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921
Mailing Address - Country:US
Mailing Address - Phone:907-826-3257
Mailing Address - Fax:907-826-3259
Practice Address - Street 1:506 3RD ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921
Practice Address - Country:US
Practice Address - Phone:907-826-3257
Practice Address - Fax:907-826-3259
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK3564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD4609Medicaid
AKMD4609Medicaid
AK151641Medicare ID - Type Unspecified