Provider Demographics
NPI:1053430538
Name:RICHARDSON, IRENE INA (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:INA
Last Name:RICHARDSON
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 1:200 SPRINGTREE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8612
Mailing Address - Country:US
Mailing Address - Phone:803-741-0044
Mailing Address - Fax:803-741-0040
Practice Address - Street 1:200 SPRINGTREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8612
Practice Address - Country:US
Practice Address - Phone:803-741-0044
Practice Address - Fax:803-741-0040
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
571127564OtherBCBS
TX143319Medicaid
SCE18159Medicare UPIN
TX143319Medicaid
571127564OtherBCBS