Provider Demographics
NPI:1457409617
Name:RICHARDSON, WILLIAM B (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:RICHARDSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:3 CURTIS ROAD TRIVALLEY FAMILY PRACTICE LLC
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-0275
Mailing Address - Country:US
Mailing Address - Phone:315-829-2220
Mailing Address - Fax:315-829-2014
Practice Address - Street 1:3 CURTIS ROAD
Practice Address - Street 2:TRIVALLEY FAMILY PRACTICE LLC
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476-0275
Practice Address - Country:US
Practice Address - Phone:315-829-2220
Practice Address - Fax:315-829-2014
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2008-06-19
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Provider Licenses
StateLicense IDTaxonomies
CT041817207Q00000X
NY243766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02879436Medicaid
NYH44629Medicare UPIN
CT080001661Medicare ID - Type Unspecified
NY02879436Medicaid