Basic Information
| Provider Information | |||||||||
| NPI: | 1356360762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPOSITO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | SY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LECOM PLACE | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 8148682522 | ||||||||
| Practice Location | |||||||||
| Address1: | 7686 WEST RIDGE RD. | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144742654 | ||||||||
| FaxNumber: | 8144742656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS010284L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0018505010005 | 05 | PA | MEDICAID |