Provider Demographics
NPI:1174556021
Name:ESCAJEDA, RICHARD TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TIMOTHY
Last Name:ESCAJEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:10188 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2906
Practice Address - Country:US
Practice Address - Phone:336-802-2070
Practice Address - Fax:336-802-2071
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1212660021OtherDME
NC8930801Medicaid
NC080083329OtherRR MEDICARE
NC1212660021OtherDME
NCE49272Medicare UPIN