Provider Demographics
NPI:1750598249
Name:STADER, RICHARD OTTO (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:OTTO
Last Name:STADER
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 1:137 LINKS OF LEITH
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7465
Mailing Address - Country:US
Mailing Address - Phone:757-258-4664
Mailing Address - Fax:
Practice Address - Street 1:5249 OLDE TOWNE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8111
Practice Address - Country:US
Practice Address - Phone:757-259-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA43206207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery