Provider Demographics
NPI:1578567137
Name:RICHMOND, KATHERINE LILY (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LILY
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 TALLMADGE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3342
Mailing Address - Country:US
Mailing Address - Phone:330-475-7535
Mailing Address - Fax:330-848-2332
Practice Address - Street 1:405 TALLMADGE RD
Practice Address - Street 2:STE 120
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3342
Practice Address - Country:US
Practice Address - Phone:330-475-7535
Practice Address - Fax:330-848-2332
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006407R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101199OtherKAISER PERMANENTE
OH513OtherSUMMA
OHP00051741OtherRAILROAD MEDICARE
OH000000215720OtherANTHEM
OH0346512Medicaid
G19162Medicare UPIN
OH000000215720OtherANTHEM