Healthcare Provider Details

I. General information

NPI: 1588617344
Provider Name (Legal Business Name): CALEB J RICHTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CHURCH ST
CARTHAGE NY
13619-1212
US

IV. Provider business mailing address

18086 GOODNOUGH ST
ADAMS CENTER NY
13606-2257
US

V. Phone/Fax

Practice location:
  • Phone: 315-493-0128
  • Fax: 315-493-6200
Mailing address:
  • Phone: 315-778-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: