Healthcare Provider Details

I. General information

NPI: 1619941663
Provider Name (Legal Business Name): RICHARD LUTHER RAUCH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HEALTH CARE LN.
MARTINSBURG WV
25401
US

IV. Provider business mailing address

123 HEALTH CARE LN.
MARTINSBURG WV
25401-8896
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-5544
  • Fax: 304-267-5545
Mailing address:
  • Phone: 304-267-5544
  • Fax: 304-267-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00191
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: