Provider Demographics
NPI:1184676488
Name:RICHARDSON, DONALD E (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PINNACLE PKWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-643-4144
Mailing Address - Fax:985-643-3603
Practice Address - Street 1:1200 PINNACLE PKWY STE 7
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-643-4144
Practice Address - Fax:985-643-3603
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008094207T00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1058840Medicaid
LAP00674774OtherRAILRAOD MEDICARE
LAP00674774OtherRAILRAOD MEDICARE
LA54851DB49Medicare PIN