Basic Information
| Provider Information | |||||||||
| NPI: | 1992786578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 697 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
| FaxNumber: | 6094632757 | ||||||||
| Practice Location | |||||||||
| Address1: | 4011 ROUTE 9 S | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082421916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098860477 | ||||||||
| FaxNumber: | 6098860529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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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 | 2085R0202X | 0008389 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0361933 | 05 | NJ | MEDICAID | 265157200 | 05 | FL | MEDICAID |