Provider Demographics
NPI:1760620678
Name:RICHI, MAYSOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYSOUN
Middle Name:
Last Name:RICHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAYSOUN
Other - Middle Name:
Other - Last Name:RICHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:385 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4240
Mailing Address - Country:US
Mailing Address - Phone:203-262-4600
Mailing Address - Fax:
Practice Address - Street 1:385 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4240
Practice Address - Country:US
Practice Address - Phone:203-262-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046124174400000X
CT46124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT46124OtherCONNECTICARE
CT9204302OtherAETBA
CT627769/528689OtherWELLCARE
CT008004181Medicaid
CT02014229OtherCOVENTRY
CTD400004080Medicare PIN