Provider Demographics
NPI:1841402559
Name:RICHARDSON, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RICHARDSON
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 549
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NH
Mailing Address - Zip Code:03846-0549
Mailing Address - Country:US
Mailing Address - Phone:603-383-9183
Mailing Address - Fax:603-383-4919
Practice Address - Street 1:RT 16 & GOODRICH FALLS RD
Practice Address - Street 2:
Practice Address - City:GLEN
Practice Address - State:NH
Practice Address - Zip Code:03838
Practice Address - Country:US
Practice Address - Phone:603-383-9183
Practice Address - Fax:603-383-4919
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7206103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009410Medicaid
NH80009410Medicaid