Provider Demographics
NPI:1477554582
Name:RICHARDSON, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WATERDAM PLAZA DR
Mailing Address - Street 2:BUILDING THREE - 2ND FLOOR
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5442
Mailing Address - Country:US
Mailing Address - Phone:724-941-7490
Mailing Address - Fax:724-941-5231
Practice Address - Street 1:1900 WATERDAM PLAZA DR
Practice Address - Street 2:BUILDING THREE - 2ND FLOOR
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5442
Practice Address - Country:US
Practice Address - Phone:724-941-7490
Practice Address - Fax:724-941-5231
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038528L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009171140014Medicaid
OH2370965Medicaid
WV1840306000Medicaid
PA460003726Medicare PIN
OH2370965Medicaid
WV1840306000Medicaid
PA460003724Medicare PIN
PA126972Q17Medicare PIN