Basic Information
| Provider Information | |||||||||
| NPI: | 1649536095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARD | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | BURGIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469100 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257694044 | ||||||||
| FaxNumber: | 2252469116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 206232 | LA | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 0101260143 | VA | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2016146739 | 05 | VA | MEDICAID |