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NPI Code Detail

MEDICARE: DANIEL RUSSELL RICHARDSON MD

MEDICARE: DANIEL RUSSELL RICHARDSON MD
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
1207WX0107XRetina Specialist (Ophthalmology) Physician26528WV

General Provider Information

NPI Number : 1639411887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL RUSSELL RICHARDSON MD
Provider Business Mailing Address
First Line : PO BOX 70100
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-0100
Country : US
Telephone Number : 304-935-0014
Fax Number :
Provider Business Practice Location Address
First Line : 333 LAIDLEY ST STE 208
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-1614
Country : US
Telephone Number : 304-935-0014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2013
Last Update Date : 12/03/2025

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