Provider Demographics
NPI:1588627970
Name:RICHARDS, JOHN PORTER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PORTER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 CHIMNEY DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4841
Mailing Address - Country:US
Mailing Address - Phone:304-935-2513
Mailing Address - Fax:304-935-2524
Practice Address - Street 1:4710 CHIMNEY DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4841
Practice Address - Country:US
Practice Address - Phone:304-935-2513
Practice Address - Fax:304-935-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1129207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110028670OtherRAILROAD MEDICARE
WV224826100OtherUS DEPT OF LABOR
WV550694936OtherUNITED HEALTHCARE MAMSI
WV004361690OtherAETNA
WV0041905000Medicaid
WV1025208OtherWORKER'S COMPENSATION
WV205562OtherCARELINK COVENTRY
WV001721126OtherBC/BS
WV7152313OtherCIGNA
WV224826100OtherUS DEPT OF LABOR
WV0496864Medicare PIN