1255316311 NPI number — RITA O PICHARDO-GEISINGER MD

Table of content: RITA O PICHARDO-GEISINGER MD (NPI 1255316311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255316311 NPI number — RITA O PICHARDO-GEISINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICHARDO-GEISINGER
Provider First Name:
RITA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PICHARDO
Provider Other First Name:
RITA
Provider Other Middle Name:
OTILIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255316311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27102-0344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-2255
Provider Business Mailing Address Fax Number:
336-716-9258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4618 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27104-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-2255
Provider Business Practice Location Address Fax Number:
336-716-9258
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0900X , with the licence number:  200500140 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NI0002X , with the licence number: 200500140 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X , with the licence number: 200500140 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5900562 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00300131 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805575 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10157838 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1381X . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810001902 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7214646 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: E0803 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".




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