Provider Demographics
NPI:1043094691
Name:RICHARDSON, MONICA REGINA
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:REGINA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4043
Mailing Address - Country:US
Mailing Address - Phone:267-694-3627
Mailing Address - Fax:
Practice Address - Street 1:707 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4043
Practice Address - Country:US
Practice Address - Phone:267-694-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies