Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C1-0024047 | DE |
Y | 208600000X | Surgeon | C1-0024047 | DE |
NPI | 1003255332 |
---|---|
Provider Name | Dr. Matthew Thomas Richards |
First Address | Lewes, DE 19958-1675 |
Second Address | Rehoboth Beach, DE 19971-4476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C1-0024047 | STATE LICENSE (01) | DE |