Healthcare Provider Details

I. General information

NPI: 1134308802
Provider Name (Legal Business Name): KINGDOM MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 BALTIMORE BLVD STE D
FINKSBURG MD
21048-1832
US

IV. Provider business mailing address

8401 SUMMIT AVE
WINDSOR MILL MD
21244-1169
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-8151
  • Fax: 443-445-4111
Mailing address:
  • Phone: 410-381-8078
  • Fax: 443-445-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD A RICHARDSON
Title or Position: OWNER
Credential: MD
Phone: 410-861-8151