Provider Demographics
NPI:1366688855
Name:PETER C RICHARDS MD,INC
Entity Type:Organization
Organization Name:PETER C RICHARDS MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:MERICLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-972-4294
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:612
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-221-0735
Mailing Address - Fax:415-221-3583
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:612
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-221-0735
Practice Address - Fax:415-221-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG475880261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE547OtherPTAN
CA1548323694OtherINDIVIDUAL NPI