Male or Other

Dr. Elliott Richelson M.D.

Psychiatry Physician in Jacksonville Beach, FL(View on Map)

Full Name

Dr. Elliott Richelson M.D.

NPI Number

1124018056

NPI Type

Individual Provider

Gender

Male

Enumeration Date

10/22/2005

Specialties

(Taxonomies)

Code

2084P0800X

Primary Taxonomy

Yes

Licenses

State

California
Florida
Massachusetts
New Hampshire
New Jersey
North Carolina
Tennessee
Wisconsin

License Number

G170998
117284
285944
EL10717
25MA10930300
264936
61847
74291-20

Contact
Information

Purpose

Mailing
Location

Address

1300 MARSH LANDING PKWY STE 112
1300 MARSH LANDING PKWY STE 112

City

Jacksonville Beach
Jacksonville Beach

State

FL
FL

Postal Code

32250-2407
32250-2407

Country

US
US

Telephone Number

(904) 456-0002
(904) 456-0002

Identifiers

Identifier

700006036
09949

Identifier State

FL
FL

Identifier Issuer

RAILROAD MEDICARE
BLUECROSS/BLUESHIELD

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/01/2022

Provider Address

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