Individual
DR. JUSTIN NICKLAUS RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44055 RIVERSIDE PKWY STE 238, LEESBURG, VA 20176-5178
(703) 858-8878
Mailing address
44055 RIVERSIDE PKWY STE 238, LEESBURG, VA 20176-5178
(703) 858-8878
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101282814
VA
208600000X
Surgery Physician
CDRH.0053765
CO
208600000X
Surgery Physician
DR.0053765
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01401976
MEDICARE RAILROAD
CO
Enumeration date
07/10/2010
Last updated
08/12/2025
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