MEDICARE: DEXTER M RICHARDSON

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	343900000X	Non-emergency Medical Transport (VAN)		VA

General Provider Information

NPI Number	:	1932671310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEXTER M RICHARDSON

Provider Business Mailing Address
First Line	:	1617 CLEAR SPRINGS CT
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5890
Country	:	US
Telephone Number	:	804-681-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 CLEAR SPRINGS CT
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5890
Country	:	US
Telephone Number	:	804-681-0346
Fax Number	:

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

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	12/21/2018

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Directions to “ DEXTER M RICHARDSON ” Practice Location

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