Provider Demographics
NPI:1164639399
Name:RICHARD, PATRICIA ANTOINETTE (MD DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANTOINETTE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:1735 POST RD UNIT 6
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-0702
Mailing Address - Country:US
Mailing Address - Phone:203-254-8080
Mailing Address - Fax:203-256-1330
Practice Address - Street 1:1735 POST RD
Practice Address - Street 2:UNIT 6
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-0702
Practice Address - Country:US
Practice Address - Phone:203-254-8080
Practice Address - Fax:203-256-1330
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5086122300000X
NY331901122300000X
PADS020377L122300000X
CT025982207R00000X, 208VP0014X
NY1469761207R00000X, 208VP0014X
PAMD028442E207R00000X, 208VP0014X
FLME45906207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No122300000XDental ProvidersDentist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D32607Medicare UPIN