Provider Demographics
NPI:1124062070
Name:RICHARDSON, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:RICHARDSON
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 1:1000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1948
Mailing Address - Country:US
Mailing Address - Phone:317-745-4451
Mailing Address - Fax:317-718-6740
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1948
Practice Address - Country:US
Practice Address - Phone:317-745-3450
Practice Address - Fax:317-745-3766
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033265207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN010045962OtherRAILROAD MEDICARE PIN
IN100378940Medicaid
INE16523Medicare UPIN
IN010045962OtherRAILROAD MEDICARE PIN
IN100378940Medicaid