Basic Information
| Provider Information | |||||||||
| NPI: | 1053380667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172631220 | ||||||||
| FaxNumber: | 7172636255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD418560 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | MD418560 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7595352 | 01 | PA | AETNA NON-HMO | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 001914298 0009 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | DEVON | OTHER | MD418560 | 01 | PA | LICENSE | OTHER | 50083245 | 01 | PA | CAPITAL BLUECROSS | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 1392240 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 6769755 | 01 | PA | AETNA HMO | OTHER | G920-0141/KDM4CU | 01 | PA | CAREFIRST | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 120420411 | 01 | PA | DEPT OF LABOR | OTHER | 2243909 | 01 | PA | UNITED HEALTHCARE (MAMSI) | OTHER | P00841782 | 01 | PA | RAILROAD MEDICARE | OTHER | 3117048 | 01 | PA | MAMSI | OTHER | BR7354145 | 01 | PA | DEA | OTHER |