MEDICARE: DR. RICHARD A SUMMA M.D.

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	207RP1001X	Pulmonary Disease Physician	R8D48	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00035728	OTHER	MO	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1558334227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A SUMMA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 DE PAUL DR STE 500
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2515
Country	:	US
Telephone Number	:	314-291-9501
Fax Number	:	314-291-9508

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	10/27/2020

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