MEDICARE: RICHARD KRUMDIECK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	9701019	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10907	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD KRUMDIECK MD

Provider Business Mailing Address
First Line	:	170 MEDICAL PARK RD
Second Line	:	STE 101
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-8540
Country	:	US
Telephone Number	:	704-799-3946
Fax Number	:	704-799-3956

Provider Business Practice Location Address
First Line	:	170 MEDICAL PARK ROAD
Second Line	:	STE 101
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-8524
Country	:	US
Telephone Number	:	704-799-3946
Fax Number	:	704-799-3956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/18/2021

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Directions to “ RICHARD KRUMDIECK MD” Practice Location

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