MEDICARE: DR. DOUGLAS SCOTT RICHARDSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101024117	VA

General Provider Information

NPI Number	:	1073586582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SCOTT RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	21495 RIDGETOP CIR
Second Line	:	SUITE 204
City	:	STERLING
State	:	VA
Zip	:	20166-6512
Country	:	US
Telephone Number	:	703-439-3939
Fax Number	:	703-430-5529

Provider Business Practice Location Address
First Line	:	21495 RIDGETOP CIR
Second Line	:	SUITE 204
City	:	STERLING
State	:	VA
Zip	:	20166-6512
Country	:	US
Telephone Number	:	703-439-3939
Fax Number	:	703-430-5529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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