Basic Information
| Provider Information | |||||||||
| NPI: | 1881689867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRYOR | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | DELMAR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120541420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184398077 | ||||||||
| FaxNumber: | 5184398070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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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 | 207P00000X | 223016-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 223016 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 121778 | 01 | NY | GHI-HMO | OTHER | 209244 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 3774Q1 | 01 | NY | EMPIRE BC | OTHER | 7017387 | 01 | NY | AETNA | OTHER | 02287401 | 05 | NY | MEDICAID | 10064178 | 01 | NY | CDPHP | OTHER | 6009640 | 01 | NY | MVP | OTHER | 000400092003 | 01 | NY | BSNENY | OTHER | 071115000068 | 01 | NY | FIDELIS | OTHER |