Healthcare Provider Details

I. General information

NPI: 1376586396
Provider Name (Legal Business Name): BRIAN K RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARFIELD AVE
PARKERSBURG WV
26101-5340
US

IV. Provider business mailing address

PO BOX 763
MORGANTOWN WV
26507-0763
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-2111
  • Fax: 904-346-0113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.084607
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21930
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: