Provider Demographics
NPI:1194739680
Name:RICHARDSON, DENISE MARIE (DPM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892
Mailing Address - Country:US
Mailing Address - Phone:252-809-1500
Mailing Address - Fax:252-809-1505
Practice Address - Street 1:411 W MAIN ST
Practice Address - Street 2:EAST CAROLINA FOOT & ANKLE SPECIALISTS PA
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892
Practice Address - Country:US
Practice Address - Phone:252-809-1500
Practice Address - Fax:252-809-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC447213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129WWMedicaid
NCU85819Medicare UPIN
NC89129WWMedicaid