Provider Demographics
NPI:1366648230
Name:RICHARDS, JEREMY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WAIALAE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-888-5228
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 208
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5312
Practice Address - Country:US
Practice Address - Phone:808-888-5228
Practice Address - Fax:808-888-7292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP5042084P0800X
NMMD2010-01442084P0800X
HIMD-184322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry