=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457409617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM B RICHARDSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2007
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 BOYNTON ST
-----------------------------------------------------
City | EASTPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04631-1397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-853-6001
-----------------------------------------------------
Fax | 207-853-4031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 275 3 CURTIS ROAD TRIVALLEY FAMILY PRACTICE LLC
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13476-0275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-829-2220
-----------------------------------------------------
Fax | 315-829-2014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 15647
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------