Provider Demographics
NPI:1225058175
Name:RICHARDS, STEPHEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 EASTON STA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7011
Mailing Address - Country:US
Mailing Address - Phone:614-759-6626
Mailing Address - Fax:614-759-8403
Practice Address - Street 1:4030 EASTON STA
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7011
Practice Address - Country:US
Practice Address - Phone:614-759-6626
Practice Address - Fax:614-759-8403
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRI0503715OtherMEDICARE
OH0426355Medicaid
OHA80182Medicare UPIN