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General NPI Number Information
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NPI Number | 1407156193
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Entity Type | Organization
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Legal Business Name | DEREK P RICHARDSON,MD,PC
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 4 IRONGATE CTR
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City | GLENS FALLS
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State | NY
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Zip | 12801-3471
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Country | US
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Telephone | 518-798-1778
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Fax | 518-798-1846
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Provider Business Mailing Address
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Address Line | 4 IRONGATE CTR
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City | GLENS FALLS
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State | NY
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Zip | 12801-3471
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Country | US
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Telephone | 518-798-1778
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Fax | 518-798-1846
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DEREK P RICHARDSON
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Credential | M.D.
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Telephone | 518-798-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 114475
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License Number State | NY
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