Healthcare Provider Details

I. General information

NPI: 1043478050
Provider Name (Legal Business Name): RICHELLE CARRIE TAKEMOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 FEDERAL ST SECOND FLOOR
PITTSBURGH PA
15212-4769
US

IV. Provider business mailing address

1307 FEDERAL ST SECOND FLOOR
PITTSBURGH PA
15212-4769
US

V. Phone/Fax

Practice location:
  • Phone: 877-660-6777
  • Fax: 412-359-3761
Mailing address:
  • Phone: 877-660-6777
  • Fax: 412-359-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD446402
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: