Provider Demographics
NPI:1891784518
Name:RICHARDS, THEODORE D (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:D
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2341 MCCALLIE AVE
Mailing Address - Street 2:PLAZA 3, STE. 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3239
Mailing Address - Country:US
Mailing Address - Phone:423-629-4106
Mailing Address - Fax:423-629-4116
Practice Address - Street 1:2341 MCCALLIE AVE
Practice Address - Street 2:PLAZA 3, STE. 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3239
Practice Address - Country:US
Practice Address - Phone:423-629-4106
Practice Address - Fax:423-629-4116
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN16113207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE59715Medicare UPIN
TN3894751Medicare PIN
TNP00160359Medicare PIN
GA06BDHQPMedicare PIN