Individual
RITA OTILIA PICHARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4618 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3520
(336) 716-2255
(336) 716-9258
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
200500140
NC
207ND0900X
Dermatopathology Physician
Primary
200500140
NC
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
200500140
NC
207NP0225X
Pediatric Dermatology Physician
200500140
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10157838
—
VA
01
—
1381X
BCBS
—
05
—
3810001902
—
WV
05
—
5900562
—
NC
01
—
7214646
AETNA
—
01
—
805575
PARTNERS
—
01
—
E0803
MEDCOST
—
01
—
P00300131
RR MEDICARE
—
Enumeration date
12/13/2005
Last updated
09/04/2024
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