Provider Demographics
NPI:1770562951
Name:RICHARDSON, LLOYD D (MD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2560 N SHADELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOILS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1706
Mailing Address - Country:US
Mailing Address - Phone:317-275-8072
Mailing Address - Fax:317-275-8124
Practice Address - Street 1:1033 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9533
Practice Address - Country:US
Practice Address - Phone:601-932-8370
Practice Address - Fax:601-939-2915
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06765207ZC0500X, 207ZP0102X, 207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124966Medicaid
MS00124966Medicaid
MSE65136Medicare UPIN
MS220000158Medicare PIN