Provider Demographics
NPI:1356344923
Name:RICHARDSON, ALEXANDER (DPM)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 W US HIGHWAY 22 AND 3
Mailing Address - Street 2:STE E
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8609
Mailing Address - Country:US
Mailing Address - Phone:513-683-2060
Mailing Address - Fax:
Practice Address - Street 1:3116 W US HIGHWAY 22 AND 3
Practice Address - Street 2:STE E
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8609
Practice Address - Country:US
Practice Address - Phone:513-683-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2159695Medicaid
OH480029911OtherRAILROAD MEDICARE
OH2159695Medicaid