Basic Information
Provider Information
NPI: 1174513386
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUGGE
FirstName: RICHARD
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 104 ENDICOTT ST
Address2: SUITE 100
City: DANVERS
State: MA
PostalCode: 019233623
CountryCode: US
TelephoneNumber: 9787456601
FaxNumber: 9786244040
Practice Location
Address1: 104 ENDICOTT ST
Address2: SUITE 100
City: DANVERS
State: MA
PostalCode: 019233623
CountryCode: US
TelephoneNumber: 9787456601
FaxNumber: 9786244040
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 12/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X208512MAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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