Healthcare Provider Details

I. General information

NPI: 1447323704
Provider Name (Legal Business Name): GEORGIA A RICHARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LANE
LARGO MD
20774-5374
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST ATTN THERESA BROOK
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-5578
  • Fax: 301-618-5673
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0058330
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101233107
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD30727
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: