MEDICARE: RICHARD M. WYATT 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	207N00000X	Dermatology Physician	155828	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000020255	OTHER	MA	BMC
2	000183947610	OTHER	MA	UNITED HEALTHCARE
3	010550144	OTHER	MA	CONSOLIDATED
4	010550144	OTHER	MA	TRICARE
5	155828	OTHER	MA	TUFTS
6	J19454	OTHER	MA	BCBSMA
7	010550144	OTHER	MA	NORTHEAST HEALTHCARE ALLI
8	010550144	OTHER	MA	PLAN VISTA
9	10550144	OTHER	MA	CONNECTICARE
10	7011791-005	OTHER	MA	CIGNA
11	401219	OTHER	MA	HARVARD PILGRIM
12	010550144	OTHER	MA	GREAT-WEST
13	010550144	OTHER	MA	PHCS
14	10550144	OTHER	MA	PIONEER HEALTH NETWORK
15	5108024	OTHER	MA	AETNA
16	010550144	OTHER	MA	NORTH AMERICAN PREFERRED
17	010550144	OTHER	MA	NORTHEAST HEALTH DIRECT
18	29546	OTHER	MA	HEALTH NEW ENGLAND

General Provider Information

NPI Number	:	1568447613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD M. WYATT MD

Provider Business Mailing Address
First Line	:	29 COTTAGE ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2178
Country	:	US
Telephone Number	:	413-549-7400
Fax Number	:	413-549-7402

Provider Business Practice Location Address
First Line	:	29B COTTAGE ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2172
Country	:	US
Telephone Number	:	413-549-7400
Fax Number	:	413-549-7402

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/03/2012

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