Provider Demographics
NPI:1659473320
Name:RICHMOND DISTRICT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RICHMOND DISTRICT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEI-LAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-752-7141
Mailing Address - Street 1:2345 BALBOA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2912
Mailing Address - Country:US
Mailing Address - Phone:415-752-7141
Mailing Address - Fax:888-220-0850
Practice Address - Street 1:2345 BALBOA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2912
Practice Address - Country:US
Practice Address - Phone:415-752-7141
Practice Address - Fax:888-220-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31979ZMedicare ID - Type Unspecified