MEDICARE: RACHEL A. RICHARDS PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	C0005390	MD

General Provider Information

NPI Number	:	1871990044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL A. RICHARDS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	4000 OLD COURT ROAD
Second Line	:	SUITE 301
City	:	BALTIMORE
State	:	MD
Zip	:	21208-6417
Country	:	US
Telephone Number	:	410-653-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 OLD COURT ROAD
Second Line	:	SUITE 301
City	:	BALTIMORE
State	:	MD
Zip	:	21208-6417
Country	:	US
Telephone Number	:	410-653-0000
Fax Number	:

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

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	07/22/2019

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