Provider Demographics
NPI:1841218005
Name:RICHARDS, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-283-8193
Mailing Address - Fax:704-283-7252
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:704-283-7252
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00251492OtherMEDICARE RAILROAD ID
NC1841218005Medicaid
NC891372PMedicaid
SC306252Medicaid
NCNC0536BMedicare PIN
NC2032645GMedicare PIN
NC2032645MMedicare PIN
NC2032645NMedicare PIN
NC2032645EMedicare PIN
NCNC0536CMedicare PIN
NC2032645CMedicare PIN
C72742Medicare UPIN
NC1841218005Medicaid
NC2032645QMedicare PIN
NCP00251492OtherMEDICARE RAILROAD ID
NC2032645JMedicare PIN
NCNC05360386Medicare PIN
NC2032645AMedicare PIN
NC2032645KMedicare PIN
NCNC0536AMedicare PIN
NC2032645DMedicare PIN
NC2032645BMedicare PIN
SC306252Medicaid
SCAA37897772Medicare PIN