Provider Demographics
NPI:1811139017
Name:PODIATRY OFFICES OF DR. MILTON RICHARDSON
Entity type:Organization
Organization Name:PODIATRY OFFICES OF DR. MILTON RICHARDSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-363-3310
Mailing Address - Street 1:1031 W WILLIAMS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3955
Mailing Address - Country:US
Mailing Address - Phone:919-363-3310
Mailing Address - Fax:919-363-3370
Practice Address - Street 1:1031 W WILLIAMS ST STE 105
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-363-3310
Practice Address - Fax:919-363-3370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILTON W. RICHARDSON DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC308213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0814NOtherBCBS
10920106OtherCIGNA
26929OtherWELLPATH
5333086OtherAETNA
NC890814NMedicaid
2752571OtherUNITED
81278OtherMEDCOST
2432375AMedicare PIN
10920106OtherCIGNA
81278OtherMEDCOST