Provider Demographics
NPI:1104315654
Name:RICHTER FAMILY MEDICINE AND WELLNESS
Entity type:Organization
Organization Name:RICHTER FAMILY MEDICINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-324-8011
Mailing Address - Street 1:1102 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4438
Mailing Address - Country:US
Mailing Address - Phone:336-324-8011
Mailing Address - Fax:336-232-9667
Practice Address - Street 1:5500 W FRIENDLY AVE STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4368
Practice Address - Country:US
Practice Address - Phone:336-324-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty