Healthcare Provider Details

I. General information

NPI: 1528633583
Provider Name (Legal Business Name): MR. CHRISTOPHER RICHARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2021
Last Update Date: 05/22/2021
Certification Date: 05/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FREDERICK AVE
AKRON OH
44310-2904
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 330-258-1293
  • Fax:
Mailing address:
  • Phone: 330-535-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0002169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: