Provider Demographics
NPI:1174746465
Name:ALBERT, RICHARD WILLIAM (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 CONNECTICUT AVE NW
Mailing Address - Street 2:103
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2318
Mailing Address - Country:US
Mailing Address - Phone:202-966-5566
Mailing Address - Fax:
Practice Address - Street 1:4444 CONNECTICUT AVE NW
Practice Address - Street 2:103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2318
Practice Address - Country:US
Practice Address - Phone:202-966-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15969207Y00000X
DC15969207YX0905X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0468120Medicaid
DC136393Medicare PIN