MEDICARE: STEPHEN RICHMOND 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	207RC0000X	Cardiovascular Disease Physician	0923831	NY

General Provider Information

NPI Number	:	1386647113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN RICHMOND M.D.

Provider Business Mailing Address
First Line	:	6814 HILLSDALE PT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3992
Country	:	US
Telephone Number	:	561-369-0973
Fax Number	:	561-369-1843

Provider Business Practice Location Address
First Line	:	6814 HILLSDALE PT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3992
Country	:	US
Telephone Number	:	561-369-0973
Fax Number	:	561-369-1843

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/08/2015

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