Provider Demographics
NPI:1639200025
Name:RICHARDS, KAROL ANNETTA (MD)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:ANNETTA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TATE BLVD SE STE 182
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-322-2005
Mailing Address - Fax:828-322-2159
Practice Address - Street 1:915 TATE BLVD SE STE 182
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-322-2005
Practice Address - Fax:828-322-2159
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034866207R00000X, 207RC0200X
NC2010-00392207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639200025Medicaid