MEDICARE: DR. PETER BRUCE RICHARDSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101032138	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180020459	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	059755	OTHER	VA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194720102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER BRUCE RICHARDSON MD

Provider Business Mailing Address
First Line	:	17 N MEDICAL PARK DR
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2344
Country	:	US
Telephone Number	:	540-213-7725
Fax Number	:	540-213-7481

Provider Business Practice Location Address
First Line	:	1500 COMMERCE RD
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401
Country	:	US
Telephone Number	:	540-213-0060
Fax Number	:	540-213-9441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/13/2010

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