Provider Demographics
NPI:1255882437
Name:RICHARDS, CALVIN (ND, PA-C)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:ND, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11236 ROBINWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6800
Mailing Address - Country:US
Mailing Address - Phone:240-313-4242
Mailing Address - Fax:
Practice Address - Street 1:11236 ROBINWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6800
Practice Address - Country:US
Practice Address - Phone:240-313-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDJ0000066175F00000X
MDC0008084363AM0700X
MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No175F00000XOther Service ProvidersNaturopath
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical