Provider Demographics
NPI:1467413419
Name:RICHARDSON, MILTON WALDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:WALDO
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 W WILLIAMS ST
Mailing Address - Street 2:#105
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3955
Mailing Address - Country:US
Mailing Address - Phone:919-363-3310
Mailing Address - Fax:919-363-3370
Practice Address - Street 1:1031 W WILLIAMS ST
Practice Address - Street 2:#105
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-363-3310
Practice Address - Fax:919-363-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC308213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
561982020OtherALL OTHER COMMERCIAL PAYO
5333086OtherAETNA
10920106OtherCIGNA
26929OtherWELLPATH
NC890814NMedicaid
0814NOtherBCBS
2752571OtherUNITED
81278OtherMEDCOST
0814NOtherBCBS
81278OtherMEDCOST
NC890814NMedicaid