Basic Information
| Provider Information | |||||||||
| NPI: | 1881012326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | WILLS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | STONY BROOK UNIVERSITY MEDICAL CTR | ||||||||
| Address2: | DEPARTMENT OF ORTHOPAEDICS HSC T-18 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441487 | ||||||||
| FaxNumber: | 6314443502 | ||||||||
| Practice Location | |||||||||
| Address1: | 13801 ST FRANCIS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231143206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2019-00946 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 0101269062 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.