Provider Demographics
NPI:1750720710
Name:KUZMA, RICHARD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KUZMA
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 1:2347 SIMONTON RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8246
Mailing Address - Country:US
Mailing Address - Phone:704-873-4719
Mailing Address - Fax:
Practice Address - Street 1:1585 FORNEY CREEK PKWY
Practice Address - Street 2:STE 2100
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9514
Practice Address - Country:US
Practice Address - Phone:704-489-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01557207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750720710Medicaid
NCNCT779AMedicare PIN