Provider Demographics
NPI:1700813888
Name:KING, RICHARD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Mailing Address - Street 1:119 RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1134
Mailing Address - Country:US
Mailing Address - Phone:585-354-7720
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:207-795-2732
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH189732086S0102X
MEMD221372086S0102X, 2086S0127X
MA2031472086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3117555Medicaid
NY02752716Medicaid
NY02752716Medicaid