Basic Information
| Provider Information | |||||||||
| NPI: | 1972618031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSBAND | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 571 SAINT JOSEPHS BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149013230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072712050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 MUD CREEK RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169479529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702973746 | ||||||||
| FaxNumber: | 5702975127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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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 | OS-005056-L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03512232 | 05 | NY | MEDICAID | 000953264 | 05 | PA | MEDICAID |