Provider Demographics
NPI:1871638411
Name:BOSTER, RICHARD BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRIAN
Last Name:BOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 RED BIRD RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-7207
Mailing Address - Country:US
Mailing Address - Phone:513-791-3566
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005
Practice Address - Country:US
Practice Address - Phone:513-705-4754
Practice Address - Fax:513-420-5156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0926243Medicaid
OH0926243Medicaid
OHE54253Medicare UPIN