Provider Demographics
NPI:1245379395
Name:THOMPSON-RICHARDS, SHIRLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:THOMPSON-RICHARDS
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 1:7401 OSLER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7622
Mailing Address - Country:US
Mailing Address - Phone:410-821-0730
Mailing Address - Fax:410-821-0732
Practice Address - Street 1:7401 OSLER DR STE 211
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7622
Practice Address - Country:US
Practice Address - Phone:410-821-0730
Practice Address - Fax:410-821-0732
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033215173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD73865Medicare UPIN