Provider Demographics
NPI:1790765899
Name:RICHARDSON, WILLIAM WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WARD
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 CLARK AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-265-8566
Mailing Address - Fax:610-878-2620
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-265-8566
Practice Address - Fax:610-878-2620
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018503E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01623479Medicaid
PA070252Medicare ID - Type Unspecified
PA01623479Medicaid