Provider Demographics
NPI:1487644837
Name:RICHARDSON, WILLIAM RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W RANDOLPH
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11 SHENANGO RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1177
Mailing Address - Country:US
Mailing Address - Phone:724-657-1881
Mailing Address - Fax:724-657-9178
Practice Address - Street 1:11 SHENANGO RD
Practice Address - Street 2:STE 1
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1177
Practice Address - Country:US
Practice Address - Phone:724-657-1881
Practice Address - Fax:724-657-9178
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045410E2084P0800X
OH35.0667522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1396705349OtherLIBERTY NPI
OH0972354Medicaid
OH0972354Medicaid
OH1396705349OtherLIBERTY NPI
OH0762311Medicare PIN