Provider Demographics
NPI:1730386434
Name:RICHARD, JEFFREY THOMAS II (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:RICHARD
Suffix:II
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:PO BOX 845398
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-5398
Mailing Address - Country:US
Mailing Address - Phone:800-684-1577
Mailing Address - Fax:
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:ER DEPT
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9052207P00000X
NH13687207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30226006Medicaid
ME432662499Medicaid
NH04Y012041NH01OtherBCBS THRU SEACOAST ER
NHP00439148OtherRAILROAD THRU SEACOAST
MA2147785Medicaid
NHAA98577OtherHARVARD PILGRIM NH
NH000256801Medicare PIN