Provider Demographics
NPI:1215085642
Name:RICHARDSON, CHARLES A (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:602-470-5063
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:SUITE E-39
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-777-5888
Practice Address - Fax:480-777-8996
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ41822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW308731Medicare PIN