Provider Demographics
NPI:1053591214
Name:RICHARD A FICHMAN MD PC
Entity type:Organization
Organization Name:RICHARD A FICHMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-649-9973
Mailing Address - Street 1:178 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5986
Mailing Address - Country:US
Mailing Address - Phone:860-264-9997
Mailing Address - Fax:
Practice Address - Street 1:178 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5986
Practice Address - Country:US
Practice Address - Phone:860-264-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD A FICHMAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001446156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0162100001Medicare NSC