Provider Demographics
NPI:1134361439
Name:SANFORD N. RICHMAN, MD, CHARTERED
Entity type:Organization
Organization Name:SANFORD N. RICHMAN, MD, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-468-7788
Mailing Address - Street 1:11500 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2735
Mailing Address - Country:US
Mailing Address - Phone:301-468-7788
Mailing Address - Fax:301-468-1188
Practice Address - Street 1:11500 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2735
Practice Address - Country:US
Practice Address - Phone:301-468-7788
Practice Address - Fax:301-468-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0011946261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD97008-1100Medicaid
MD019438Medicare UPIN