Provider Demographics
NPI:1548266034
Name:DAMSCHRODER, RICHARD L (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:DAMSCHRODER
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 1:830 W HIGH ST
Mailing Address - Street 2:STE 304
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3978
Mailing Address - Country:US
Mailing Address - Phone:419-228-9098
Mailing Address - Fax:419-222-6604
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:STE 304
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3978
Practice Address - Country:US
Practice Address - Phone:419-228-9098
Practice Address - Fax:419-222-6604
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-7492-D207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0463761Medicaid
OHDA0506421Medicare PIN
A80226Medicare UPIN