Provider Demographics
NPI:1083631246
Name:RICHARDSON, AMY C (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000526092OtherANTHEM
OH734679OtherBUCKEYE
OH0842011Medicaid
OH648156OtherAETNA
OH000000028336OtherANTHEM
OH370001953OtherRAILROAD MEDICARE
OH000000221423OtherUNISON
OH842011OtherBCMH
OH363954OtherWELLCARE
OH363954OtherWELLCARE
OH734679OtherBUCKEYE
OHE28243Medicare UPIN