Provider Demographics
NPI:1174523112
Name:PARIS, RICHARD TODD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TODD
Last Name:PARIS
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:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-0683
Mailing Address - Country:US
Mailing Address - Phone:908-277-8878
Mailing Address - Fax:908-673-7132
Practice Address - Street 1:1 DIAMOND HILL ROAD
Practice Address - Street 2:
Practice Address - City:BERKELEY HTS
Practice Address - State:NEW JERSEY
Practice Address - Zip Code:07922
Practice Address - Country:UM
Practice Address - Phone:908-277-8878
Practice Address - Fax:908-673-7132
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06102500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6953301Medicaid
NJ6953301Medicaid
F99884Medicare UPIN