Provider Demographics
NPI:1871345710
Name:LINSTON, RICHARD ROBERT
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name:LINSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 CHASELINE RDG
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3514
Mailing Address - Country:US
Mailing Address - Phone:216-323-0252
Mailing Address - Fax:
Practice Address - Street 1:4413 CHASELINE RDG
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3514
Practice Address - Country:US
Practice Address - Phone:216-323-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRH506964172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver