Provider Demographics
NPI:1568439438
Name:RICHESON, NANCY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANNE
Last Name:RICHESON
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 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-540-1000
Mailing Address - Fax:803-540-1050
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 501
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-255-3451
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02958469Medicaid
SC103346Medicaid
B915747004Medicare ID - Type UnspecifiedRESIDENT TEACHING CLINIC
B91574Medicare UPIN
SC103346Medicaid
SCB195747004Medicare PIN
SCB195742603Medicare PIN