Basic Information
| Provider Information | |||||||||
| NPI: | 1447224555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICKLEY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73221 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781354 | ||||||||
| FaxNumber: | 4125784981 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 FRIENDSHIP AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781354 | ||||||||
| FaxNumber: | 4125784981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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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 | 207L00000X | MD038531E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2252360 | 05 | OH | MEDICAID | 3002597000 | 05 | WV | MEDICAID | 0010891640009 | 05 | PA | MEDICAID | P00337146 | 01 | PA | RAILROAD MEDICARE | OTHER |