Provider Demographics
NPI:1780806331
Name:RICHARD A DICKES MD PA
Entity type:Organization
Organization Name:RICHARD A DICKES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-267-1238
Mailing Address - Street 1:310 MADISON AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6967
Mailing Address - Country:US
Mailing Address - Phone:973-267-1238
Mailing Address - Fax:973-540-8849
Practice Address - Street 1:310 MADISON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6967
Practice Address - Country:US
Practice Address - Phone:973-267-1238
Practice Address - Fax:973-540-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA026924002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461290UQKMedicare ID - Type UnspecifiedRENDERING NUMBER
NJ095476Medicare PIN