Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0S006291L | PA |
NPI | 1013990639 |
---|---|
Provider Name | Dr. William Bruce Richwine |
First Address | Camp Hill, PA 17011-4707 |
Second Address | Camp Hill, PA 17011-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 05/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01617622104 | (05) | PA |
C49100 | (02) |