Provider Demographics
NPI:1255316311
Name:PICHARDO-GEISINGER, RITA O (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:O
Last Name:PICHARDO-GEISINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:OTILIA
Other - Last Name:PICHARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-9258
Practice Address - Street 1:4618 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3520
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-9258
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500140207ND0900X, 207NI0002X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900562Medicaid
P00300131OtherRR MEDICARE
805575OtherPARTNERS
VA10157838Medicaid
1381XOtherBCBS
WV3810001902Medicaid
7214646OtherAETNA
E0803OtherMEDCOST
1381XOtherBCBS
NC5900562Medicaid