MEDICARE: CHARLES A RICHERT 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD00035845	WA

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

General Provider Information

NPI Number	:	1376502260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A RICHERT MD

Provider Business Mailing Address
First Line	:	PO BOX 3941
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-3941
Country	:	US
Telephone Number	:	360-459-7770
Fax Number	:	360-459-4361

Provider Business Practice Location Address
First Line	:	413 LILLY RD NE
Second Line	:	PROVIDENCE ST PETER HOSPITAL
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5166
Country	:	US
Telephone Number	:	360-491-9480
Fax Number	:	360-459-4361

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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