Provider Demographics
NPI:1073586582
Name:RICHARDSON, DOUGLAS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21495 RIDGETOP CIR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6512
Mailing Address - Country:US
Mailing Address - Phone:703-439-3939
Mailing Address - Fax:703-430-5529
Practice Address - Street 1:21495 RIDGETOP CIR
Practice Address - Street 2:SUITE 204
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6512
Practice Address - Country:US
Practice Address - Phone:703-439-3939
Practice Address - Fax:703-430-5529
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101024117207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB07720Medicare UPIN