Provider Demographics
NPI:1487693768
Name:PILEGGI, RICHARD D (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:PILEGGI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1110
Mailing Address - Country:US
Mailing Address - Phone:856-222-4444
Mailing Address - Fax:856-222-4733
Practice Address - Street 1:4000 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1110
Practice Address - Country:US
Practice Address - Phone:856-222-4444
Practice Address - Fax:856-222-4733
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P72542Medicare UPIN