Provider Demographics
NPI:1932159829
Name:CARVOLTH, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:CARVOLTH
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 1:5000 HOPYARD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3348
Mailing Address - Country:US
Mailing Address - Phone:925-924-1600
Mailing Address - Fax:925-924-0601
Practice Address - Street 1:5000 HOPYARD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3348
Practice Address - Country:US
Practice Address - Phone:925-924-1600
Practice Address - Fax:925-924-0506
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG39595207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G395950Medicaid
CO00G395950Medicare ID - Type Unspecified
CA00G395950Medicaid