Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2977 | WV |
NPI | 1265746325 |
---|---|
Provider Name | Dr. Thomas A Richardson |
First Address | Lewisburg, WV 24901-1380 |
Second Address | Lewisburg, WV 24901-1380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2010 |
Last Update Date | 03/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810030218 | (05) | WV |