Basic Information
| Provider Information | |||||||||
| NPI: | 1346400207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISHRA | ||||||||
| FirstName: | RICHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969200 | ||||||||
| FaxNumber: | 8567969397 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 HADDON AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564297512 | ||||||||
| FaxNumber: | 8564297104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 06/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 25MA08901100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 390200000X | MT18890 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 7447409 | 01 | NJ | CIGNA | OTHER | 0285749 | 05 | NJ | MEDICAID | 3876079000 | 01 | NJ | AMERIHEALTH | OTHER |