Basic Information
| Provider Information | |||||||||
| NPI: | 1568447993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 COUNTY RTE 51 | ||||||||
| Address2: | |||||||||
| City: | MALONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129534504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184830109 | ||||||||
| FaxNumber: | 5184830115 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 COUNTY RTE 51 | ||||||||
| Address2: | |||||||||
| City: | MALONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129534504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184830109 | ||||||||
| FaxNumber: | 5184830115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 213152 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 213152-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | RA8810 | 01 | NY | FRANKLIN COUNTY NURSING H | OTHER | 01955586 | 05 | NY | MEDICAID | 01995615 | 05 | NY | MEDICAID | BB7507 | 01 | NY | ALICE HYDE MEDICAL CENTER | OTHER |