Provider Demographics
NPI:1093797839
Name:RICHARDSON, AUBREY (MD)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARY
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5005
Mailing Address - Country:US
Mailing Address - Phone:615-345-5400
Mailing Address - Fax:888-468-6603
Practice Address - Street 1:164 ENGLISH RUN CIR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152
Practice Address - Country:US
Practice Address - Phone:615-345-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00621372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459216Medicaid
IN200806530Medicaid
MD644921-01OtherCAREFIRST BLUE CROSS BLUE SHIELD
CT001434159Medicaid
MD00612800Medicaid
GA235975740AMedicaid
AL510-03185OtherBLUE CROSS BLUE SHIELD ALABAMA
KS2003709990AMedicaid
MO207588500Medicaid
MI841328305Medicaid
NY02730367Medicaid
IN20806530Medicaid
NC5902869Medicaid
WA8472870Medicaid
NV100511920Medicaid
SC274205Medicaid
PA3154394OtherCIGNA
CO77339860Medicaid
AKMD5457Medicaid
VA010237092Medicaid
AZ038877Medicaid
PA1018044950001Medicaid
TN4490744Medicaid
MD9372608OtherPRIVATE HEALTHCARE SYSTEMS
AZ038877Medicaid
MD00612800Medicaid