Provider Demographics
NPI:1013983550
Name:RICHARDS, DICK A (PA-C)
Entity Type:Individual
Prefix:
First Name:DICK
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-316-1050
Mailing Address - Fax:704-316-1051
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 175
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-316-1050
Practice Address - Fax:704-316-1051
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101711Medicaid
NCP00353924OtherRAILROAD MEDICARE
NCP00353924OtherRAILROAD MEDICARE
NCNC2287AMedicare PIN
NC2751870AMedicare PIN
NCS81110Medicare UPIN
NC2751870EMedicare PIN