Provider Demographics
NPI:1326132416
Name:RICHMOND PEDIATRIC & ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:RICHMOND PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-434-5090
Mailing Address - Street 1:12 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-4410
Mailing Address - Country:US
Mailing Address - Phone:802-434-5090
Mailing Address - Fax:802-329-2144
Practice Address - Street 1:12 BURNETT CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-4410
Practice Address - Country:US
Practice Address - Phone:802-434-5090
Practice Address - Fax:802-329-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011571Medicaid
VTRICH00068256OtherBCBS GROUP ID #
VTG38453Medicare UPIN
VTH84190Medicare UPIN