Provider Demographics
NPI:1710907365
Name:RICHARDS, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4403
Mailing Address - Country:US
Mailing Address - Phone:814-336-6308
Mailing Address - Fax:814-337-6067
Practice Address - Street 1:462 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4403
Practice Address - Country:US
Practice Address - Phone:814-336-6308
Practice Address - Fax:814-337-6067
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048730L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013906350005Medicaid
PA260047417OtherMEDICARE RAILROAD
PA205036OtherUPMC
PA177964OtherVALUE OPTIONS
PA260047417OtherMEDICARE RAILROAD
PA205036OtherUPMC