Provider Demographics
NPI:1366521908
Name:RICHARDSON, MADISON F (MD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:F
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8500 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 908
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3121
Mailing Address - Country:US
Mailing Address - Phone:310-360-9520
Mailing Address - Fax:310-360-9526
Practice Address - Street 1:8500 WILSHIRE BLVD
Practice Address - Street 2:SUITE 908
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-360-9520
Practice Address - Fax:310-360-9526
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG18826207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G188260Medicaid
CA00G188260Medicaid
CAW14876AMedicare ID - Type UnspecifiedVOICE
CA00G188260Medicaid