Healthcare Provider Details

I. General information

NPI: 1821079039
Provider Name (Legal Business Name): LAURA RICHARDSON P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 ARDMORE BLVD
PITTSBURGH PA
15221-4405
US

IV. Provider business mailing address

1713 ARDMORE BLVD
PITTSBURGH PA
15221-4405
US

V. Phone/Fax

Practice location:
  • Phone: 412-247-3222
  • Fax: 412-247-3229
Mailing address:
  • Phone: 412-247-3222
  • Fax: 412-247-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA001521L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: