Provider Demographics
NPI:1346840162
Name:RICAHRDSON, QUARTEZ
Entity Type:Individual
Prefix:
First Name:QUARTEZ
Middle Name:
Last Name:RICAHRDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 AMERICAN WAY APT 535
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-4536
Mailing Address - Country:US
Mailing Address - Phone:210-528-8672
Mailing Address - Fax:
Practice Address - Street 1:250 AMERICAN WAY APT 535
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-4536
Practice Address - Country:US
Practice Address - Phone:210-528-8672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians