Provider Demographics
NPI:1770594715
Name:RICHTER, EDWIN F III (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:F
Last Name:RICHTER
Suffix:III
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 1:29 HOSPITAL PLAZA
Mailing Address - Street 2:STE 495
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-316-0610
Mailing Address - Fax:203-969-7418
Practice Address - Street 1:29 HOSPITAL PLAZA
Practice Address - Street 2:STE 495
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-316-0610
Practice Address - Fax:203-969-7418
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043144208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431444Medicaid
TINOtherPOMCO
CT4522972007OtherCIGNA
TINOtherFOCUS
TINOtherCORVEL
TINOtherNATIONAL PROVIDER NETWORK
TINOtherNEHD
CT3880662OtherAETNA
CTP3600729OtherOXFORD HEALTH PLANS
TINOtherUNITED HEALTHCARE
CT010043144CT01OtherANTHEM BC/BS
CT043144OtherCONNECTICARE
TINOtherFIRST HEALTH
CT1371JOtherEMPIRE BC/BS
CT2V6536OtherHEALTH NET
TINOtherPIONEER
TINOtherPHCS
TINOtherPIONEER
CT4522972007OtherCIGNA
TINOtherFIRST HEALTH