1366688855 NPI number — PETER C RICHARDS MD,INC

Table of content: (NPI 1366688855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366688855 NPI number — PETER C RICHARDS MD,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER C RICHARDS MD,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366688855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3838 CALIFORNIA ST
Provider Second Line Business Mailing Address:
612
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94118-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-221-0735
Provider Business Mailing Address Fax Number:
415-221-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3838 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
612
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-221-0735
Provider Business Practice Location Address Fax Number:
415-221-3583
Provider Enumeration Date:
01/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERICLE
Authorized Official First Name:
AGNES
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
415-972-4294

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X , with the licence number:  G475880 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BE547 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1548323694 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".