Healthcare Provider Details

I. General information

NPI: 1114739117
Provider Name (Legal Business Name): RICHA JOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PENNSYLVANIA AVE STE A
FORT WASHINGTON PA
19034-3317
US

IV. Provider business mailing address

3500 N BROAD ST RM 1A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-540-8408
  • Fax: 215-540-8418
Mailing address:
  • Phone: 215-926-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD487649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: