Provider Demographics
NPI:1053384750
Name:RICHARDSON, LEONARD A (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1169
Mailing Address - Country:US
Mailing Address - Phone:410-336-4932
Mailing Address - Fax:443-445-4111
Practice Address - Street 1:9520 BERGER RD STE 212
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1543
Practice Address - Country:US
Practice Address - Phone:410-381-8078
Practice Address - Fax:443-445-4111
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057722207Q00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10242541OtherAMERIGROUP
8113427OtherCIGNA
MD693604100Medicaid
MDG501-0001OtherCAREFIRST