Healthcare Provider Details

I. General information

NPI: 1497962690
Provider Name (Legal Business Name): MICHAEL RICHMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20304 TIMBERLAKE RD
LYNCHBURG VA
24502-7222
US

IV. Provider business mailing address

1309 EYRIE VIEW DR
LYNCHBURG VA
24503-6571
US

V. Phone/Fax

Practice location:
  • Phone: 434-333-6799
  • Fax:
Mailing address:
  • Phone: 540-798-8477
  • Fax: 434-333-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number0101239222
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101239222
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: