Provider Demographics
NPI:1982700514
Name:ROSELAVENDER A. RICHARDS, M.D. P.C.
Entity Type:Organization
Organization Name:ROSELAVENDER A. RICHARDS, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSELAVENDAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-6997
Mailing Address - Street 1:1201 W GOLDFINCH WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3144
Mailing Address - Country:US
Mailing Address - Phone:480-786-0899
Mailing Address - Fax:480-963-1752
Practice Address - Street 1:515 W BUCKEYE RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2648
Practice Address - Country:US
Practice Address - Phone:602-258-6997
Practice Address - Fax:602-257-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23096173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318205Medicaid
AZ77493Medicare ID - Type Unspecified
AZF43522Medicare UPIN