Healthcare Provider Details

I. General information

NPI: 1184194847
Provider Name (Legal Business Name): RICHARD KENTON PLOURDE JR. C PED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 EMMET ST N
CHARLOTTESVILLE VA
22903-4834
US

IV. Provider business mailing address

1621 QUAIL RUN
CHARLOTTESVILLE VA
22911-9054
US

V. Phone/Fax

Practice location:
  • Phone: 434-245-0205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: