Provider Demographics
NPI:1073618278
Name:RICHESON DRIVE PEDIATRICS, INC.
Entity Type:Organization
Organization Name:RICHESON DRIVE PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-385-7776
Mailing Address - Street 1:105 RICHESON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2911
Mailing Address - Country:US
Mailing Address - Phone:434-385-7776
Mailing Address - Fax:434-385-5846
Practice Address - Street 1:105 RICHESON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2911
Practice Address - Country:US
Practice Address - Phone:434-385-7776
Practice Address - Fax:434-385-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty