Richardson, Derek Proctor

Richardson, Derek Proctor is an individual health care provider with primary practice located at Four Irongate Center , Glens Falls NY 12801. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Richardson, Derek Proctor can be contacted via phone (518) 798-1778.

Contact Information

Primary practice address
Four Irongate Center Glens Falls NY 12801
Phone: (518) 798-1778
Fax: (518) 798-1846
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 114475 New York

Profile Details

NPI number 1568552719
LBN Legal business name Richardson, Derek Proctor
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2006
Last updated Oct 28th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568552719 NPPES
New York Other 000407083001 BLUE SHIELD
New York Other 040426007626 BLUE SHIELD
New York Other 07121 BLUE SHIELD
New York Other 10001709 BLUE SHIELD
New York Other 141622071 BLUE SHIELD
New York Other 48F2111 BLUE SHIELD
New York MEDICAID 00352149 BLUE SHIELD

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