Healthcare Provider Details

I. General information

NPI: 1811970296
Provider Name (Legal Business Name): VICTOR R RISCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CEDAR CREST I78
ALLENTOWN AL
18105
US

IV. Provider business mailing address

1020A E BOAL AVE
BOALSBURG PA
16827-1509
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-0700
  • Fax:
Mailing address:
  • Phone: 814-237-8627
  • Fax: 814-238-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD025945E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: