Provider Demographics
NPI:1871784397
Name:RICHARD O. WRIGHT, MD PC
Entity type:Organization
Organization Name:RICHARD O. WRIGHT, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:OSBORNE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-628-1599
Mailing Address - Street 1:1401 TIDEWATER DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2840
Mailing Address - Country:US
Mailing Address - Phone:757-628-1599
Mailing Address - Fax:757-274-1600
Practice Address - Street 1:1401 TIDEWATER DR
Practice Address - Street 2:SUITE 6
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2840
Practice Address - Country:US
Practice Address - Phone:757-628-1599
Practice Address - Fax:757-274-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7367724Medicaid
F32586Medicare UPIN
VAC10581Medicare PIN