Healthcare Provider Details

I. General information

NPI: 1659938959
Provider Name (Legal Business Name): TONY RICHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS HEAD AND NECK SURGICAL ONCOLOGY
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

1324 LOCUST ST APT 1102
PHILADELPHIA PA
19107-5651
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-4898
  • Fax:
Mailing address:
  • Phone: 267-401-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number100234-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: