Provider Demographics
NPI:1992970776
Name:ALEXANDER JOHN RICHARDSON DPM
Entity type:Organization
Organization Name:ALEXANDER JOHN RICHARDSON DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-683-2060
Mailing Address - Street 1:3116 W US RT 22 AND 3
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039
Mailing Address - Country:US
Mailing Address - Phone:513-683-2060
Mailing Address - Fax:513-683-3132
Practice Address - Street 1:3116 W US RT 22 AND 3
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039
Practice Address - Country:US
Practice Address - Phone:513-683-2060
Practice Address - Fax:513-683-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4460190001Medicare NSC