Provider Demographics
NPI:1811283211
Name:PIERSON, RICHARD ALAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:PIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7282 POTOMAC FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-7341
Mailing Address - Country:US
Mailing Address - Phone:208-709-3425
Mailing Address - Fax:
Practice Address - Street 1:17457 CAFFEE RD STE 204
Practice Address - Street 2:
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448-5120
Practice Address - Country:US
Practice Address - Phone:540-653-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11793207Q00000X
VA0101256282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine