Provider Demographics
NPI:1851698112
Name:RICHMOND FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:RICHMOND FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MILLETT
Authorized Official - Last Name:GOODYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-578-8058
Mailing Address - Street 1:30 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-4479
Mailing Address - Country:US
Mailing Address - Phone:802-434-4123
Mailing Address - Fax:802-434-3130
Practice Address - Street 1:30 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477
Practice Address - Country:US
Practice Address - Phone:802-434-4123
Practice Address - Fax:802-434-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty