Provider Demographics
NPI:1457081903
Name:RICHARDSON, MADDISON (PA)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1133
Mailing Address - Country:US
Mailing Address - Phone:716-326-3240
Mailing Address - Fax:716-326-3233
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1133
Practice Address - Country:US
Practice Address - Phone:716-326-3240
Practice Address - Fax:716-326-3233
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical