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General NPI Number Information
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NPI Number | 1851779730
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Entity Type | Organization
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Legal Business Name | ELISABETH G. RICHARD, MD PA
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 10753 FALLS RD SUITE 355, PAVILION II
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-847-3700
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Fax | 410-847-3703
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Provider Business Mailing Address
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Address Line | 10753 FALLS RD SUITE 355, PAVILION II
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-847-3700
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Fax | 410-847-3703
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Authorized Official
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Title or Position | PHYSICIAN, DIRECTOR, PRESIDENT
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Name | ELISABETH G. RICHARD
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Credential | M.D.
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Telephone | 410-847-3700
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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 | D0062684
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License Number State | MD
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