Provider Demographics
NPI:1144340076
Name:DAVID RICH M D INC
Entity type:Organization
Organization Name:DAVID RICH M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-797-0222
Mailing Address - Street 1:2959 CANFIELD RD
Mailing Address - Street 2:SUITES 8 & 9
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2800
Mailing Address - Country:US
Mailing Address - Phone:330-797-0222
Mailing Address - Fax:330-797-0058
Practice Address - Street 1:2959 CANFIELD RD
Practice Address - Street 2:SUITES 8 & 9
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2800
Practice Address - Country:US
Practice Address - Phone:330-797-0222
Practice Address - Fax:330-797-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0914934Medicaid
OHCJ3168OtherRR MEDICARE
OH0914934Medicaid