Provider Demographics
NPI:1689771701
Name:TRADER, RICHARD LLOYD (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LLOYD
Last Name:TRADER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WALLY CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1523
Mailing Address - Country:US
Mailing Address - Phone:410-560-1530
Mailing Address - Fax:
Practice Address - Street 1:1300 YORK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:410-821-9620
Practice Address - Fax:410-821-9624
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL0002311363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q69238Medicare UPIN