Provider Demographics
NPI:1144366311
Name:D'AMICO, RICHARD J (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2925
Mailing Address - Country:US
Mailing Address - Phone:917-596-5070
Mailing Address - Fax:518-324-3077
Practice Address - Street 1:74 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2925
Practice Address - Country:US
Practice Address - Phone:518-324-3074
Practice Address - Fax:518-324-3077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6L111Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY06938GMedicare PIN
NY00695941Medicaid