| Mr Richard Henry Koehler, MD | |
|
510 South 4th Street, Fulton, NY 13069 | |
| (315) 592-3510 | |
| (315) 452-2510 |
| Full Name | Mr Richard Henry Koehler |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 510 South 4th Street, Fulton, New York |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073575023 | NPI | - | NPPES |
| 02357486 | Medicaid | NY | |
| 1073575023 | Medicaid | NY | |
| 1073575023 | Other | NY | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 144511 (New York) | Primary |
| Entity Name | Port City Emergency Physicians Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134370547 PECOS PAC ID: 0345301917 Enrollment ID: O20081202000420 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Richard Henry Koehler, MD 2736 Chadsworth Lane, Southport, NC 28461 Ph: (315) 440-5507 | Mr Richard Henry Koehler, MD 510 South 4th Street, Fulton, NY 13069 Ph: (315) 592-3510 |
Dr. Sanjay Ramachandran, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 522 South Fourth St Ste 500, Fulton Health Center, Fulton, NY 13069 Phone: 315-598-4790 Fax: 315-598-4719 | |
Dennis Mullaney, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 510 S 4th St, Fulton, NY 13069 Phone: 315-591-9442 Fax: 315-591-9448 |