Healthcare Provider Details

I. General information

NPI: 1639355423
Provider Name (Legal Business Name): CELINE RICHARDSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

IV. Provider business mailing address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-7878
  • Fax:
Mailing address:
  • Phone: 703-359-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number001499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: