Provider Demographics
NPI:1891063715
Name:PADRICK, RICHARD GREGORY (LIC AC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GREGORY
Last Name:PADRICK
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5851
Mailing Address - Country:US
Mailing Address - Phone:410-871-1664
Mailing Address - Fax:
Practice Address - Street 1:112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5851
Practice Address - Country:US
Practice Address - Phone:410-871-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist