Provider Demographics
NPI:1578812335
Name:ROBERTA M RICHARDSON MD LLC
Entity Type:Organization
Organization Name:ROBERTA M RICHARDSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-233-1450
Mailing Address - Street 1:950 WADSWORTH BLVD
Mailing Address - Street 2:STE 308
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4591
Mailing Address - Country:US
Mailing Address - Phone:303-233-1450
Mailing Address - Fax:303-233-1119
Practice Address - Street 1:950 WADSWORTH BLVD
Practice Address - Street 2:STE 308
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4591
Practice Address - Country:US
Practice Address - Phone:303-233-1450
Practice Address - Fax:303-233-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO264232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01264233Medicaid
C76271Medicare PIN
E91947Medicare UPIN