Provider Demographics
NPI:1386647113
Name:RICHMOND, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:RICHMOND
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 1:6814 HILLSDALE PT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3992
Mailing Address - Country:US
Mailing Address - Phone:561-369-0973
Mailing Address - Fax:561-369-1843
Practice Address - Street 1:6814 HILLSDALE PT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3992
Practice Address - Country:US
Practice Address - Phone:561-369-0973
Practice Address - Fax:561-369-1843
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0923831207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19923Medicare UPIN
NYB19923Medicare UPIN