Provider Demographics
NPI:1386140135
Name:RICHARDSON, JOSEPH R (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:DO
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 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:276-386-3411
Mailing Address - Fax:276-386-3492
Practice Address - Street 1:390 KANE ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-2753
Practice Address - Country:US
Practice Address - Phone:276-386-3411
Practice Address - Fax:276-386-3492
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4415207Q00000X
VA0102206483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine