Provider Demographics
NPI:1780677724
Name:RICHARDSON, TADARRO L (MD)
Entity Type:Individual
Prefix:
First Name:TADARRO
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE C215
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-9413
Mailing Address - Fax:859-276-6381
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C215
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-9413
Practice Address - Fax:859-276-6381
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611012421COtherHUMANA
KY64-203599Medicaid
KYC68011OtherBLUEGRASS FAMILY HEALTH
KY000000047826OtherANTHEM BLUE SHIELD
KY61-1012421OtherTPN CONTRACTS
KY110031156OtherRAILROAD MEDICARE
KY1404232OtherUMWA
KY0037678OtherMEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT
KY1284109OtherUMWA
KY611012421OtherAETNA
KY0076503Medicare ID - Type UnspecifiedMEDICARE
KYC68011Medicare UPIN
KY64-203599Medicaid