Basic Information
| Provider Information | |||||||||
| NPI: | 1285631754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAMEWOOD | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | BRYANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516110 | ||||||||
| FaxNumber: | 7178511999 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT ROAD | ||||||||
| Address2: | SUITE #120 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516110 | ||||||||
| FaxNumber: | 7178511999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D0028146 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD436419 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 340521400 | 05 | MD | MEDICAID | 20090503 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 268842 | 01 | PA | UNISON-WMG | OTHER | 102291062 | 05 | PA | MEDICAID | 1581781 | 01 | PA | GATEWAY | OTHER | 208475 | 01 | MD | CAREFIRST MD BCBS | OTHER | 2099253 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |