Provider Demographics
NPI:1316008626
Name:RICHMOND PEDIATRICS
Entity Type:Organization
Organization Name:RICHMOND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMSUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-895-4140
Mailing Address - Street 1:1219 ROCKINGHAM ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379
Mailing Address - Country:US
Mailing Address - Phone:910-895-4140
Mailing Address - Fax:910-895-4091
Practice Address - Street 1:1219 ROCKINGHAM ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-895-4140
Practice Address - Fax:910-895-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601645208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1030AOtherBCBS
NC891030AMedicaid
G45672Medicare UPIN