Healthcare Provider Details

I. General information

NPI: 1730187030
Provider Name (Legal Business Name): RICHARD CONOVER MEAD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR STE 180
FREDERICK MD
21702-4509
US

IV. Provider business mailing address

501 FAIRMOUNT AVE STE 302
TOWSON MD
21286-5494
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-7478
  • Fax: 301-620-7479
Mailing address:
  • Phone: 410-927-8768
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305203943
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16283
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11085
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4488
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2305203943
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: