Healthcare Provider Details

I. General information

NPI: 1023713005
Provider Name (Legal Business Name): RICHMOND SARPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MITCHELLVILLE RD STE B222
BOWIE MD
20716-3148
US

IV. Provider business mailing address

PO BOX 356
BURTONSVILLE MD
20866-0356
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-3775
  • Fax: 301-358-3211
Mailing address:
  • Phone: 301-421-1125
  • Fax: 301-500-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29329
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29239
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: