Provider Demographics
NPI:1508887944
Name:RICHARDSON, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 NORTH FRANKLIN DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-225-6500
Mailing Address - Fax:724-229-2170
Practice Address - Street 1:125 NORTH FRANKLIN DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-225-6500
Practice Address - Fax:724-229-2170
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY234512207R00000X
PAMD430480207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI28712Medicare UPIN