Provider Demographics
NPI:1134161037
Name:RICHARD, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-282-3495
Mailing Address - Fax:866-886-7232
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-282-3495
Practice Address - Fax:866-886-7232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE45976Medicare UPIN