Provider Demographics
NPI:1811630700
Name:BOURGUILLON, RICHARD OLIVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:OLIVIER
Last Name:BOURGUILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 PEACHTREE RD NW APT 822
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1641
Mailing Address - Country:US
Mailing Address - Phone:678-887-9095
Mailing Address - Fax:
Practice Address - Street 1:203 LOTHROP ST STE 300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2548
Practice Address - Country:US
Practice Address - Phone:412-647-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty