1205606951 NPI number — MARK WAYNE RICHARDSON ACUPUNCTURIST

Table of content: MARK WAYNE RICHARDSON ACUPUNCTURIST (NPI 1205606951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205606951 NPI number — MARK WAYNE RICHARDSON ACUPUNCTURIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
MARK
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACUPUNCTURIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205606951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 WALNUT ST STE 1306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19102-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-817-1298
Provider Business Mailing Address Fax Number:
215-735-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7750 MONTPELIER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20723-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-817-1298
Provider Business Practice Location Address Fax Number:
215-735-0079
Provider Enumeration Date:
01/04/2024

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: 171100000X , with the licence number:  U02991 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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