Healthcare Provider Details

I. General information

NPI: 1558479220
Provider Name (Legal Business Name): LUKE GREGORY RICHARDS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HUNTINGTON AVE
BOSTON MA
02115-4808
US

IV. Provider business mailing address

81 W CHAPEL ST
ABINGTON MA
02351-1920
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone: 161-760-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO2239
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: