Basic Information
| Provider Information | |||||||||
| NPI: | 1093797839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | AUBREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WRIGHT | ||||||||
| OtherFirstName: | TERESA | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 MARYLAND FARMS STE 200 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455400 | ||||||||
| FaxNumber: | 8884686603 | ||||||||
| Practice Location | |||||||||
| Address1: | 164 ENGLISH RUN CIR | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | D0062137 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1459216 | 05 | LA | MEDICAID | 200806530 | 05 | IN | MEDICAID | 644921-01 | 01 | MD | CAREFIRST BLUE CROSS BLUE SHIELD | OTHER | 001434159 | 05 | CT | MEDICAID | 00612800 | 05 | MD | MEDICAID | 235975740A | 05 | GA | MEDICAID | 510-03185 | 01 | AL | BLUE CROSS BLUE SHIELD ALABAMA | OTHER | 2003709990A | 05 | KS | MEDICAID | 207588500 | 05 | MO | MEDICAID | 841328305 | 05 | MI | MEDICAID | 02730367 | 05 | NY | MEDICAID | 20806530 | 05 | IN | MEDICAID | 5902869 | 05 | NC | MEDICAID | 8472870 | 05 | WA | MEDICAID | 100511920 | 05 | NV | MEDICAID | 274205 | 05 | SC | MEDICAID | 3154394 | 01 | PA | CIGNA | OTHER | 77339860 | 05 | CO | MEDICAID | MD5457 | 05 | AK | MEDICAID | 010237092 | 05 | VA | MEDICAID | 038877 | 05 | AZ | MEDICAID | 1018044950001 | 05 | PA | MEDICAID | 4490744 | 05 | TN | MEDICAID | 9372608 | 01 | MD | PRIVATE HEALTHCARE SYSTEMS | OTHER |