Healthcare Provider Details

I. General information

NPI: 1720009368
Provider Name (Legal Business Name): RICHARD H. ISRAEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MEDICAL PARK DR SUITE 211
SILVER SPRING MD
20902-4053
US

IV. Provider business mailing address

2101 MEDICAL PARK DR SUITE 211
SILVER SPRING MD
20902-4053
US

V. Phone/Fax

Practice location:
  • Phone: 301-589-3277
  • Fax: 301-589-3632
Mailing address:
  • Phone: 301-589-3277
  • Fax: 301-589-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00014
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: