MEDICARE: MR. RICHARD L CAUDELL DPM

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	213E00000X	Podiatrist	0103000442	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497755136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD L CAUDELL DPM

Provider Business Mailing Address
First Line	:	3660 BOULEVARD
Second Line	:	STE B
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1345
Country	:	US
Telephone Number	:	804-520-4144
Fax Number	:	804-520-4144

Provider Business Practice Location Address
First Line	:	3660 BOULEVARD
Second Line	:	STE B
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1345
Country	:	US
Telephone Number	:	804-520-4144
Fax Number	:	804-520-4144

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/02/2010

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