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NPI Code Detail

MEDICARE: DR. RICHARD A WANTZ ED.D.

MEDICARE: DR. RICHARD A WANTZ ED.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
1103T00000XPsychologist4517OH

Other Identifiers

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

General Provider Information

NPI Number : 1669490025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD A WANTZ ED.D.
Provider Business Mailing Address
First Line : 1354 LEMCKE RD
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45434-6727
Country : US
Telephone Number : 937-657-7655
Fax Number : 937-775-2042
Provider Business Practice Location Address
First Line : 1411 N FAIRFIELD RD
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45432-2658
Country : US
Telephone Number : 937-426-2686
Fax Number : 937-426-2686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/09/2007

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Directions to “ DR. RICHARD A WANTZ ED.D.” Practice Location

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