Healthcare Provider Details

I. General information

NPI: 1437103462
Provider Name (Legal Business Name): RICHARD EARNHARDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 211
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

106 BOSCOBEL RD
FREDERICKSBURG VA
22405-6143
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-2244
  • Fax: 540-371-4849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101045947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: