Provider Demographics
NPI:1881616217
Name:KITTLE, RICHARD ERIC (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:KITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:ERIC
Other - Last Name:KITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1044 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307-1508
Mailing Address - Country:US
Mailing Address - Phone:518-370-1441
Mailing Address - Fax:518-395-9431
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-475-7000
Practice Address - Fax:518-525-7050
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263898207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY53099AOtherMEDICARE PIN
NY331833OtherMEDICARE OSCAR