Provider Demographics
NPI:1730218363
Name:RICHMOND TOTAL MEDICAL, P.C.
Entity type:Organization
Organization Name:RICHMOND TOTAL MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-317-5960
Mailing Address - Street 1:131 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2819
Mailing Address - Country:US
Mailing Address - Phone:718-317-5960
Mailing Address - Fax:718-317-5961
Practice Address - Street 1:1776 RICHMOND RD
Practice Address - Street 2:SUITE 5
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2581
Practice Address - Country:US
Practice Address - Phone:718-668-9300
Practice Address - Fax:718-668-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211722208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02060699Medicaid
NY02060699Medicaid
58C411Medicare ID - Type Unspecified