Provider Demographics
NPI:1821004698
Name:AGUIRRE, RICHARD S (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:AGUIRRE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5989 BIG TREE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9719
Mailing Address - Country:US
Mailing Address - Phone:585-346-4460
Mailing Address - Fax:585-346-4463
Practice Address - Street 1:5989 BIG TREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4460
Practice Address - Fax:585-346-4463
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068546Medicaid
NYRA0255Medicare PIN
NY02068546Medicaid