Provider Demographics
NPI:1932176765
Name:RICHARDSON, DONALD WINGFIELD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WINGFIELD
Last Name:RICHARDSON
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-7055
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-7055
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039755207R00000X, 207RE0101X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA055028OtherANTHEM
VA006013201Medicaid
VAPAROtherCORVEL/CORCARE
NC0663UOtherBC/BS
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA15571OtherSENTARA OPTIMA
VAPAROtherMULTIPLAN
VA-033OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCIGNA
VAPAROtherVIRGINIA HEALTH NETWORK
NC890633UMedicaid
VAPAROtherUSA MANAGED CARE
VA223346OtherUHC/MAMSI
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VA15571OtherSENTARA OPTIMA
VA460000680Medicare PIN