Healthcare Provider Details

I. General information

NPI: 1346400207
Provider Name (Legal Business Name): RICHA MISHRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HADDON AVE STE 100
HADDON TOWNSHIP NJ
08108-2809
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-7512
  • Fax: 856-429-7104
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA08901100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT18890
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: