MEDICARE: SYDNEY G RICHARD PA

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	363A00000X	Physician Assistant	0110010914	VA

General Provider Information

NPI Number	:	1861282642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY G RICHARD PA

Provider Business Mailing Address
First Line	:	7130 GLEN FOREST DR STE 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-3754
Country	:	US
Telephone Number	:	804-662-6138
Fax Number	:	804-282-2601

Provider Business Practice Location Address
First Line	:	12129 GRAHAM MEADOWS DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-6661
Country	:	US
Telephone Number	:	804-288-4084
Fax Number	:	804-282-2601

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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