Provider Demographics
NPI:1235416181
Name:RICHARDSON, LAUREN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:FAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 GLENSIDE DR
Mailing Address - Street 2:STE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-2762
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:110 N ROBINSON STREET
Practice Address - Street 2:#400
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-822-3480
Practice Address - Fax:804-822-3484
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003666363AM0700X
VA00110003666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical