Provider Demographics
NPI:1396125209
Name:RICHARDSON, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:TELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 PHYSICIANS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5351
Mailing Address - Country:US
Mailing Address - Phone:843-970-1560
Mailing Address - Fax:843-745-9428
Practice Address - Street 1:1027 PHYSICIANS DR STE 110
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5351
Practice Address - Country:US
Practice Address - Phone:843-970-1560
Practice Address - Fax:843-745-9428
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD82265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology