Provider Demographics
NPI:1184674707
Name:RICHARDSON, BERTHA PARTHENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:PARTHENIA
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 1:320 LILLINGTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3188
Mailing Address - Country:US
Mailing Address - Phone:704-372-0638
Mailing Address - Fax:704-372-0632
Practice Address - Street 1:320 LILLINGTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3188
Practice Address - Country:US
Practice Address - Phone:704-372-0638
Practice Address - Fax:704-372-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21856207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
21872OtherPARTNERS HEALTHCARE
71541OtherBCBS OF NC
NC8971541Medicaid
NC202684Medicare ID - Type Unspecified
NC8971541Medicaid