Healthcare Provider Details

I. General information

NPI: 1962598714
Provider Name (Legal Business Name): BRYAN K RICHMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WASHINGTON STREET, E SUITE 103
CHARLESTON WV
25301
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 700
CHARLESTON WV
25304-1230
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7270
  • Fax: 304-388-7280
Mailing address:
  • Phone: 304-347-1300
  • Fax: 304-347-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17819
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: