=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194720102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER BRUCE RICHARDSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 05/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 COMMERCE RD
-----------------------------------------------------
City | STAUNTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-213-0060
-----------------------------------------------------
Fax | 540-213-9441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 N MEDICAL PARK DR
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-213-7725
-----------------------------------------------------
Fax | 540-213-7481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 0101032138
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------