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NPI Code Detail

MEDICARE: WENDELL L RICHARDSON M.D.

MEDICARE: WENDELL L RICHARDSON M.D.
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
1207Q00000XFamily Medicine Physician2006-01430NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1144CAOTHERNCBCBS OF NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700953940
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDELL L RICHARDSON M.D.
Provider Business Mailing Address
First Line : 1212 S WALNUT ST
Second Line :
City : FAIRMONT
State : NC
Zip : 28340-1848
Country : US
Telephone Number : 910-628-6711
Fax Number : 910-628-5735
Provider Business Practice Location Address
First Line : 1212 S WALNUT ST
Second Line :
City : FAIRMONT
State : NC
Zip : 28340-1848
Country : US
Telephone Number : 910-628-6711
Fax Number : 910-628-5735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/09/2007

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