Provider Demographics
NPI:1720038136
Name:RICHARDSON, CHRISTIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:N
Last Name:RICHARDSON
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 1:4414 LAKE BOONE TRL STE 308
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7514
Mailing Address - Country:US
Mailing Address - Phone:919-781-7450
Mailing Address - Fax:919-781-8324
Practice Address - Street 1:4414 LAKE BOONE TRL STE 308
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7514
Practice Address - Country:US
Practice Address - Phone:919-781-7450
Practice Address - Fax:919-781-8324
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01052207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI51687Medicare UPIN
NC2051336Medicare ID - Type Unspecified