Provider Demographics
NPI:1326489063
Name:RICHARDS, ELLIOTT GRANT (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:GRANT
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-6476
Mailing Address - Fax:336-716-0194
Practice Address - Street 1:111 HANESTOWN CT STE 351
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1749
Practice Address - Country:US
Practice Address - Phone:336-716-6476
Practice Address - Fax:336-716-0194
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131163207V00000X, 207VE0102X
390200000X
NC2025-01793207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program