Provider Demographics
NPI:1548248677
Name:BYRNES, RICHARD D (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:BYRNES
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 1:650 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1219
Mailing Address - Country:US
Mailing Address - Phone:215-723-8972
Mailing Address - Fax:215-723-8961
Practice Address - Street 1:650 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1219
Practice Address - Country:US
Practice Address - Phone:215-723-8972
Practice Address - Fax:215-723-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003066L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006146620001Medicaid
PA0006146620001Medicaid