Provider Demographics
NPI:1881601086
Name:NORD, RICHARD G (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:NORD
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 1:904 SAHARA TRAIL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3667
Mailing Address - Country:US
Mailing Address - Phone:330-758-9787
Mailing Address - Fax:330-758-9792
Practice Address - Street 1:904 SAHARA TRAIL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-758-9787
Practice Address - Fax:330-758-9792
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063170208800000X
PAMD039501E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0956390Medicaid
OH1900341OtherUNITED HEALTH CARE
OH1900406OtherUNITED HEALTH CARE
OH1900533OtherUNITED HEALTH CARE
GA340010058OtherPALMETTO GBA RR MEDICARE
PAN0402246OtherHIGHMARK
OH000000137270OtherANTHEM
OH83078OtherQUALCHOICE
OH0956390Medicaid
OH000000137270OtherANTHEM
OHNO0714933Medicare PIN
GA340010058OtherPALMETTO GBA RR MEDICARE