Healthcare Provider Details

I. General information

NPI: 1194720102
Provider Name (Legal Business Name): PETER BRUCE RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COMMERCE RD
STAUNTON VA
24401
US

IV. Provider business mailing address

17 N MEDICAL PARK DR
FISHERSVILLE VA
22939-2344
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-0060
  • Fax: 540-213-9441
Mailing address:
  • Phone: 540-213-7725
  • Fax: 540-213-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101032138
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: