Provider Demographics
NPI:1477623734
Name:RICHARDSON, MARK WORDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WORDEN
Last Name:RICHARDSON
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 1:3333 N CALVERT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6501
Mailing Address - Country:US
Mailing Address - Phone:410-554-6679
Mailing Address - Fax:410-554-2740
Practice Address - Street 1:25 MONUMENT RD STE 290
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5073
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-812-4092
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9611207X00000X
PAMD045027L207XX0801X, 207X00000X
MDD0083697207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20090718OtherAMERIHEALTH MERCY
MD951704OtherCAREFIRST MD BCBS
PA102308043Medicaid
PA1582870OtherGATEWAY-WMG
PA2105495OtherHIGHMARK BLUE SHIELD
PA276293OtherUNISON HEALTH PLAN (WMG)
PA276293OtherUNISON HEALTH PLAN (WMG)
PA102308043Medicaid
RI4228761Medicare PIN