Provider Demographics
NPI:1871557728
Name:RICHMOND, MEREDITH NONE (MD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:NONE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BONITA COMMUNITY HEALTH CENTER, INC
Mailing Address - Street 2:3501 HEALTH CENTER BLVD
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-949-6142
Mailing Address - Fax:239-949-6104
Practice Address - Street 1:BONITA COMMUNITY HEALTH CENTER
Practice Address - Street 2:3501 HEALTH CENTER BLVD
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-949-6152
Practice Address - Fax:239-949-6104
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101266174400000X, 207Q00000X
FLME118169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2291439BMedicare PIN
VAD000Medicare UPIN