# RICHMOND PEDIATRIC & ADOLESCENT MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326132416
- **Authorized official:** PAUL J PARKER MD (PHYSICIAN)
- **Authorized official phone:** (802) 434-5090

## Contact information

- **Practice address:** 12 BURNETT CT, RICHMOND, VT 05477-4410
- **Practice address phone:** (802) 434-5090
- **Practice address fax:** (802) 329-2144
- **Mailing address:** 12 BURNETT CT, RICHMOND, VT 05477-4410
- **Mailing address phone:** (802) 434-5090
- **Mailing address fax:** (802) 329-2144

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 0420010554 | VT | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 12/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1011571 | — | VT |
| 01 | — | RICH00068256 | BCBS GROUP ID \# | VT |