Provider Demographics
NPI:1730187030
Name:MEAD, RICHARD CONOVER (PT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CONOVER
Last Name:MEAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5494
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:141 THOMAS JOHNSON DR STE 180
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4509
Practice Address - Country:US
Practice Address - Phone:301-620-7478
Practice Address - Fax:301-620-7479
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052039432251X0800X, 2251S0007X, 2251S0007X, 2251X0800X
MD16283225100000X, 2251X0800X
AZ11085225100000X
NM4488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA421638175OtherTRICARE
VA165675OtherBCBS
421638175OtherTAX ID NUMBER
MD579PMedicare PIN
VA165675OtherBCBS
VA00W186R01Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
MD579P198HMedicare PIN