Provider Demographics
NPI:1831115567
Name:FINGERLE, RICHARD ERNEST (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERNEST
Last Name:FINGERLE
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:PO BOX 60280
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0280
Mailing Address - Country:US
Mailing Address - Phone:770-424-7808
Mailing Address - Fax:770-237-4980
Practice Address - Street 1:833 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 111
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1134
Practice Address - Country:US
Practice Address - Phone:770-424-7800
Practice Address - Fax:770-426-8572
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023046207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00379926AMedicaid
GA45038OtherBLUE CROSS/ BLUE SHIELD
GA22BDCCGMedicare ID - Type Unspecified
GA00379926AMedicaid