Individual
THERESA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
140 CANAL VIEW BLVD, SUITE 102, ROCHESTER, NY 14623-2808
(585) 338-2700
(585) 242-9663
Mailing address
140 CANAL VIEW BLVD, SUITE 102, ROCHESTER, NY 14623-2808
(585) 338-2700
(585) 242-9663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004950
NY
363AM0700X
Medical Physician Assistant
Primary
004950
NY
363AM0700X
Medical Physician Assistant
4950
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000918196001
HEALTHNOW
—
01
—
918196001
COMMUNITY BLUE
—
01
—
PA0169
PREFERRED CARE
—
01
—
PO19004950
BLUE CHOICE
—
Enumeration date
10/19/2006
Last updated
05/15/2023
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