Provider Demographics
NPI:1306033634
Name:RICHARDSON, KATHERINE JAUDON (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JAUDON
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:4050 BRIDGE VIEW DR STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8415
Mailing Address - Country:US
Mailing Address - Phone:843-953-0082
Mailing Address - Fax:
Practice Address - Street 1:4050 BRIDGE VIEW DR STE 600
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-953-0038
Practice Address - Fax:843-953-0051
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD7452Medicare PIN