MEDICARE: CHARLES M RICHWINE IV DO, LORI TIERNO RICHWINE DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MB54693	NJ

General Provider Information

NPI Number	:	1891846895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES M RICHWINE IV DO, LORI TIERNO RICHWINE DO PC

Provider Business Mailing Address
First Line	:	3110 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7734
Country	:	US
Telephone Number	:	609-927-9555
Fax Number	:	609-926-8902

Provider Business Practice Location Address
First Line	:	3110 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7734
Country	:	US
Telephone Number	:	609-927-9555
Fax Number	:	609-926-8902

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PATRICIA A GONZALEZ
Credential	:
Telephone Number	:	609-927-9555

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	05/20/2011

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