MEDICARE: DANIEL DALE RICHARDSON 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	208600000X	Surgery Physician	9600700	NC
2	208600000X	Surgery Physician	036263	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00322237	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2223843B	OTHER	NC	AETNA
3	7908120	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1851338172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DALE RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	615 E 12TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3408
Country	:	US
Telephone Number	:	252-946-0181
Fax Number	:	252-946-7774

Provider Business Practice Location Address
First Line	:	615 E 12TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3408
Country	:	US
Telephone Number	:	252-946-0181
Fax Number	:	252-946-7774

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/02/2012

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