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1255316311

NPI Code Detail

MEDICARE: RITA OTILIA PICHARDO MD

MEDICARE: RITA OTILIA PICHARDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	200500140	NC
2	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	200500140	NC
3	207NP0225X	Pediatric Dermatology Physician	200500140	NC
4	207ND0900X	Dermatopathology Physician	200500140	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00300131	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1381X	OTHER		BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	E0803	OTHER		MEDCOST
6	7214646	OTHER		AETNA
8	805575	OTHER		PARTNERS

General Provider Information

NPI Number	:	1255316311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA OTILIA PICHARDO MD

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	4618 COUNTRY CLUB RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-3520
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-9258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	09/04/2024

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Directions to “ RITA OTILIA PICHARDO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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