Provider Demographics
NPI:1851779730
Name:ELISABETH G. RICHARD, MD PA
Entity Type:Organization
Organization Name:ELISABETH G. RICHARD, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, DIRECTOR, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-847-3700
Mailing Address - Street 1:10753 FALLS RD
Mailing Address - Street 2:SUITE 355, PAVILION II
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4535
Mailing Address - Country:US
Mailing Address - Phone:410-847-3700
Mailing Address - Fax:410-847-3703
Practice Address - Street 1:10753 FALLS RD
Practice Address - Street 2:SUITE 355, PAVILION II
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4535
Practice Address - Country:US
Practice Address - Phone:410-847-3700
Practice Address - Fax:410-847-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062684207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty