Provider Demographics
NPI:1588604466
Name:RICHARDSON, NORMAN S (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N
Other - Middle Name:SELBY
Other - Last Name:RICHARDSON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11450
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685
Mailing Address - Country:US
Mailing Address - Phone:800-509-8102
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH LIVE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:MONKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-761-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC140449Medicaid
SCD177332987Medicare PIN
SC930009620Medicare PIN
D17733Medicare UPIN
SC140449Medicaid