Healthcare Provider Details

I. General information

NPI: 1871913186
Provider Name (Legal Business Name): ELIZABETH RICHARDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

30 WATERCHASE DR
ROCKY HILL CT
06067-2110
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-6840
  • Fax:
Mailing address:
  • Phone: 860-257-4131
  • Fax: 860-257-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS018467
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number67988
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: