Healthcare Provider Details

I. General information

NPI: 1922008861
Provider Name (Legal Business Name): JOSEPH L RICHERTS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD SUITE 501
PHILADELPHIA PA
19114-1025
US

IV. Provider business mailing address

9501 ROOSEVELT BLVD SUITE 501
PHILADELPHIA PA
19114-1025
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-4280
  • Fax: 215-464-9034
Mailing address:
  • Phone: 215-671-4280
  • Fax: 215-464-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD045583-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD045583L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: