Provider Demographics
NPI:1386377547
Name:RICHARDS, COLDEN
Entity type:Individual
Prefix:
First Name:COLDEN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BUCKLEY RD APT 9
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3675
Mailing Address - Country:US
Mailing Address - Phone:315-212-8242
Mailing Address - Fax:
Practice Address - Street 1:4800 BUCKLEY RD APT 9
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3675
Practice Address - Country:US
Practice Address - Phone:315-212-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program