Provider Demographics
NPI:1871624189
Name:PURSE, RICHARD MUNRO
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MUNRO
Last Name:PURSE
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 1:6981 N PARK DR
Mailing Address - Street 2:506
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4205
Mailing Address - Country:US
Mailing Address - Phone:856-317-0506
Mailing Address - Fax:856-317-0352
Practice Address - Street 1:6981 N PARK DR
Practice Address - Street 2:506
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4205
Practice Address - Country:US
Practice Address - Phone:856-317-0506
Practice Address - Fax:856-317-0352
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003000L2085R0202X
NJMB058831002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6301304Medicaid
PA000753245Medicaid
PA137984Medicare PIN
NJ6301304Medicaid
PA000753245Medicaid