Provider Demographics
NPI:1902138720
Name:CHILDS, RICHARD WYATT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WYATT
Last Name:CHILDS
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 1:10 CENTER DR
Mailing Address - Street 2:BLDG 10, CRC ROOM 3E-5330
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-594-8008
Mailing Address - Fax:301-480-2664
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BLDG 10, CRC ROOM 3E-5330
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-594-8008
Practice Address - Fax:301-480-2664
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00048201171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider