Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101-032096 | VA |
NPI | 1003057530 |
---|---|
Provider Name | Pamela H Richardson |
First Address | Goochland, VA 23063 |
Second Address | Goochland, VA 23063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2009 |
Last Update Date | 12/03/2009 |