Provider Demographics
NPI:1235496811
Name:RICHARDS, EBONY MAKEDA (MD)
Entity Type:Individual
Prefix:DR
First Name:EBONY
Middle Name:MAKEDA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14139 POTOMAC MILLS ROAD
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-359-7878
Mailing Address - Fax:703-490-7695
Practice Address - Street 1:14139 POTOMAC MILLS ROAD
Practice Address - Street 2:PEDIATRICS
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-359-7878
Practice Address - Fax:703-490-7695
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics