Healthcare Provider Details

I. General information

NPI: 1134292899
Provider Name (Legal Business Name): RICHARD G. PESTELL M.D., PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST SUITE G4240
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8874
  • Fax: 215-955-2340
Mailing address:
  • Phone: 215-955-9457
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD429307
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD429307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: