MEDICARE: RICHARD CHADWICK FORD 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	2084P0800X	Psychiatry Physician	28399	SC

General Provider Information

NPI Number	:	1235154667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHADWICK FORD M.D.

Provider Business Mailing Address
First Line	:	25 CLARK SUMMIT DR
Second Line	:	SUITE F201
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4205
Country	:	US
Telephone Number	:	843-757-4737
Fax Number	:	843-757-4585

Provider Business Practice Location Address
First Line	:	25 CLARK SUMMIT DR
Second Line	:	SUITE F201
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4205
Country	:	US
Telephone Number	:	843-757-4737
Fax Number	:	843-757-4585

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/03/2008

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