Healthcare Provider Details

I. General information

NPI: 1609966886
Provider Name (Legal Business Name): RICHARD IVAN PLOTZKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W BALTIMORE PIKE SUITE 210
WEST GROVE PA
19390-9402
US

IV. Provider business mailing address

213 REECEVILLE RD SUITE 17
COATESVILLE PA
19320-1573
US

V. Phone/Fax

Practice location:
  • Phone: 610-869-2224
  • Fax: 610-869-1481
Mailing address:
  • Phone: 610-384-2021
  • Fax: 610-384-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD014709E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: