Basic Information
| Provider Information | |||||||||
| NPI: | 1124430160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 SUTTER ST | ||||||||
| Address2: | FL. 2 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156586791 | ||||||||
| FaxNumber: | 4155200904 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 DARTMOUTH ST STE 603 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021165883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172245351 | ||||||||
| FaxNumber: | 6179035009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 260385 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 269776 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.