MEDICARE: BONITA F RICHARDSON CERTIFICATION

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	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	0226600531	DC

General Provider Information

NPI Number	:	1407701154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA F RICHARDSON CERTIFICATION

Provider Business Mailing Address
First Line	:	528 50TH PL NE APT 21
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5408
Country	:	US
Telephone Number	:	202-902-3468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 PENNSYLVANIA AVE NW STE 1025
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20006-3951
Country	:	US
Telephone Number	:	202-902-3468
Fax Number	:

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

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/28/2026

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