Provider Demographics
NPI:1699703165
Name:PILLA, RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PILLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 LONGFORD RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3632
Mailing Address - Country:US
Mailing Address - Phone:856-673-1751
Mailing Address - Fax:856-831-7141
Practice Address - Street 1:3020 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1562
Practice Address - Country:US
Practice Address - Phone:610-563-0380
Practice Address - Fax:206-203-1075
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04457600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52716Medicare UPIN
NJ160141Medicare ID - Type Unspecified