Healthcare Provider Details

I. General information

NPI: 1124062070
Provider Name (Legal Business Name): THOMAS A RICHARDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST EMERGENCY DEPARTMENT
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-3450
  • Fax: 317-745-3766
Mailing address:
  • Phone: 317-745-4451
  • Fax: 317-718-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01033265
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: