Provider Demographics
NPI:1881012326
Name:RICHARDSON, MEGHAN WILLS (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:WILLS
Last Name:RICHARDSON
Suffix:
Gender:F
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:STONY BROOK UNIVERSITY MEDICAL CTR
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDICS HSC T-18
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:631-444-1487
Mailing Address - Fax:631-444-3502
Practice Address - Street 1:13801 ST FRANCIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3206
Practice Address - Country:US
Practice Address - Phone:804-270-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00946207X00000X
390200000X
VA0101269062207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program