Provider Demographics
NPI:1578312161
Name:KINGDOM MEDICINE SHEPHERD PARK INC.
Entity type:Organization
Organization Name:KINGDOM MEDICINE SHEPHERD PARK INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-336-4932
Mailing Address - Street 1:7824 EASTERN AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1303
Mailing Address - Country:US
Mailing Address - Phone:202-525-1306
Mailing Address - Fax:443-445-4111
Practice Address - Street 1:7824 EASTERN AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1303
Practice Address - Country:US
Practice Address - Phone:202-525-1306
Practice Address - Fax:443-445-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty