Healthcare Provider Details

I. General information

NPI: 1174605067
Provider Name (Legal Business Name): KENNETH EDWIN RICHTER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 EDGEMEADE RD
UPPER MARLBORO MD
20772-8088
US

IV. Provider business mailing address

3601 PICKETT RD UNIT 2489
FAIRFAX VA
22031-8123
US

V. Phone/Fax

Practice location:
  • Phone: 301-358-0192
  • Fax:
Mailing address:
  • Phone: 619-203-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102208516
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A10813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: