Provider Demographics
NPI:1861539843
Name:NOCELLA, RICHARD ANDREW JR (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDREW
Last Name:NOCELLA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOLGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13329-1413
Mailing Address - Country:US
Mailing Address - Phone:315-429-9011
Mailing Address - Fax:
Practice Address - Street 1:301 N WASHINGTON ST STE 2300
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2907
Practice Address - Country:US
Practice Address - Phone:315-867-1176
Practice Address - Fax:315-867-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310870Medicaid
NY330148Medicare ID - Type Unspecified
NY00310870Medicaid