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General NPI Number Information
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NPI Number | 1164984977
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Entity Type | Organization
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Legal Business Name | KINGDOM MEDICINE ADMINISTRATIVE SERVICES, INC.
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 07/07/2024
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Provider Practice Location Address
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Address Line | 90 PAINTERS MILL RD STE 205
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3614
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Country | US
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Telephone | 410-907-1565
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Fax | 443-445-4111
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Provider Business Mailing Address
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Address Line | 8401 SUMMIT AVE
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City | WINDSOR MILL
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State | MD
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Zip | 21244-1169
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONARD ALLISON RICHARDSON
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Credential | MD
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Telephone | 410-381-8078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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