Healthcare Provider Details

I. General information

NPI: 1841402559
Provider Name (Legal Business Name): ROBERT RICHARDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 16 & GOODRICH FALLS RD
GLEN NH
03838
US

IV. Provider business mailing address

PO BOX 549
JACKSON NH
03846-0549
US

V. Phone/Fax

Practice location:
  • Phone: 603-383-9183
  • Fax: 603-383-4919
Mailing address:
  • Phone: 603-383-9183
  • Fax: 603-383-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number7206
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: