MEDICARE: MRS. MEGAN RICHARDSON FNP-C

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	363LF0000X	Family Nurse Practitioner	AC001133	MD

General Provider Information

NPI Number	:	1699118786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN RICHARDSON FNP-C

Provider Business Mailing Address
First Line	:	11717 OLD NATIONAL PIKE
Second Line	:	SUITE #8
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6154
Country	:	US
Telephone Number	:	301-882-7489
Fax Number	:	301-882-7520

Provider Business Practice Location Address
First Line	:	11717 OLD NATIONAL PIKE
Second Line	:	SUITE #8
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6154
Country	:	US
Telephone Number	:	301-882-7489
Fax Number	:	301-882-7520

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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