Provider Demographics
NPI:1932154093
Name:RICHARD, ELISABETH G (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:G
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10753 FALLS RD
Mailing Address - Street 2:SUITE 355, PAVILION II
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4535
Mailing Address - Country:US
Mailing Address - Phone:410-847-3700
Mailing Address - Fax:
Practice Address - Street 1:10753 FALLS RD
Practice Address - Street 2:SUITE 355, PAVILION II
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4535
Practice Address - Country:US
Practice Address - Phone:410-847-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62684207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408272900Medicaid
MD161825ZFGBMedicare PIN
MD408272900Medicaid
MDI33766Medicare UPIN