Provider Demographics
NPI:1184754129
Name:EGLOW, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:EGLOW
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 1:2200 BURDETT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2451
Mailing Address - Country:US
Mailing Address - Phone:518-272-0800
Mailing Address - Fax:518-272-0843
Practice Address - Street 1:2200 BURDETT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2451
Practice Address - Country:US
Practice Address - Phone:518-272-0800
Practice Address - Fax:518-272-0843
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182961Medicaid
NY01182961Medicaid
NYE15233Medicare UPIN