Provider Demographics
NPI:1396827051
Name:RICHARDSON, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:RIDERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21139
Mailing Address - Country:US
Mailing Address - Phone:410-598-8779
Mailing Address - Fax:410-377-4322
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE #4430
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-6212
Practice Address - Fax:410-377-4322
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018442208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34873005OtherCAREFIRST BCBS
MDR5250004OtherCAREFIRST BCBS
DCR5250004OtherCAREFIRST BCBS
MD308571600Medicaid
D74405Medicare UPIN
MD34873005OtherCAREFIRST BCBS
MD308571600Medicaid