Provider Demographics
NPI:1073684015
Name:RICHARDS, RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SW CENTER ST.
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341
Mailing Address - Country:US
Mailing Address - Phone:910-267-0421
Mailing Address - Fax:910-267-0441
Practice Address - Street 1:444 SW CENTER ST.
Practice Address - Street 2:
Practice Address - City:FAISON
Practice Address - State:NC
Practice Address - Zip Code:28341
Practice Address - Country:US
Practice Address - Phone:910-267-0421
Practice Address - Fax:910-267-0441
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01863207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics