Provider Demographics
NPI:1891037578
Name:RICHARDSON-OLIVIER, CHALESE KATCHE (MD)
Entity type:Individual
Prefix:
First Name:CHALESE
Middle Name:KATCHE
Last Name:RICHARDSON-OLIVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHALESE
Other - Middle Name:KATCHE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHALESE RICHARDSON
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:187-741-2343
Mailing Address - Fax:187-920-4351
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-741-2343
Practice Address - Fax:718-920-4351
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2774212080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics