Provider Demographics
NPI:1861432544
Name:NORTH, RICHARD BOYDSTON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BOYDSTON
Last Name:NORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:5051 GREENSPRING AVE
Practice Address - Street 2:MICHEL MIROWSKI, MD, OFF. BLDG
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4355
Practice Address - Country:US
Practice Address - Phone:410-601-1950
Practice Address - Fax:410-601-1951
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29506207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD319671200Medicaid
MDS567R628Medicare PIN
MD319671200Medicaid