Provider Demographics
NPI:1932230430
Name:EDWARD G RICHMAN M.D., LLC
Entity Type:Organization
Organization Name:EDWARD G RICHMAN M.D., LLC
Other - Org Name:EDWARD G RICHMAN MD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-475-8860
Mailing Address - Street 1:2616 LONGWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3704
Mailing Address - Country:US
Mailing Address - Phone:302-475-8860
Mailing Address - Fax:302-475-1648
Practice Address - Street 1:2500 GRUBB RD
Practice Address - Street 2:BRANDYWOOD PLAZA, SUITE 110
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4799
Practice Address - Country:US
Practice Address - Phone:302-475-8860
Practice Address - Fax:302-475-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000942602Medicaid