Provider Demographics
NPI:1922425669
Name:JEANNINE GEORGE-RICHARDSON, DPM
Entity Type:Organization
Organization Name:JEANNINE GEORGE-RICHARDSON, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEORGE-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-869-4147
Mailing Address - Street 1:2201 SAVANNAH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7536
Mailing Address - Country:US
Mailing Address - Phone:410-489-4747
Mailing Address - Fax:410-869-4149
Practice Address - Street 1:2 E ROLLING CROSSROADS
Practice Address - Street 2:SUITE 152
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:410-869-4147
Practice Address - Fax:410-869-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01417332B00000X
DCPO1000047332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6709300002OtherDME
MD6709300001OtherDME
MD445613100Medicaid
MD445613100Medicaid