1235416181 NPI number — MRS. LAUREN MARIE RICHARDSON PA-C

Table of content: MRS. LAUREN MARIE RICHARDSON PA-C (NPI 1235416181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235416181 NPI number — MRS. LAUREN MARIE RICHARDSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
LAUREN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAIG
Provider Other First Name:
LAUREN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235416181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 GLENSIDE DR
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-288-2762
Provider Business Mailing Address Fax Number:
804-285-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N ROBINSON STREET
Provider Second Line Business Practice Location Address:
#400
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-822-3480
Provider Business Practice Location Address Fax Number:
804-822-3484
Provider Enumeration Date:
11/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  0110003666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 00110003666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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