Provider Demographics
NPI:1215000468
Name:RICHARDSON, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3520 PARK AVENUE BLVD.
Mailing Address - Street 2:STE 105
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466
Mailing Address - Country:US
Mailing Address - Phone:854-999-8300
Mailing Address - Fax:877-326-3482
Practice Address - Street 1:3520 PARK AVENUE BLVD.
Practice Address - Street 2:STE 105
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:854-999-8300
Practice Address - Fax:877-326-3482
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA229853207L00000X
SC25014208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology