Provider Demographics
NPI:1871990044
Name:RICHARDS, RACHEL A (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD COURT ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6417
Mailing Address - Country:US
Mailing Address - Phone:410-653-0000
Mailing Address - Fax:
Practice Address - Street 1:4000 OLD COURT ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6417
Practice Address - Country:US
Practice Address - Phone:410-653-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD779LMedicare PIN