Provider Demographics
NPI:1578054599
Name:RICHARD, NOAH NA SR
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:NA
Last Name:RICHARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6961
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-6961
Mailing Address - Country:US
Mailing Address - Phone:571-339-4985
Mailing Address - Fax:
Practice Address - Street 1:675 BERRYVILLE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5663
Practice Address - Country:US
Practice Address - Phone:571-339-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAN12-761343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)