MEDICARE: RICHARD ALLEN GINGRICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD05470	OR

General Provider Information

NPI Number	:	1912063801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLEN GINGRICH MD

Provider Business Mailing Address
First Line	:	1805 E 19TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-3365
Country	:	US
Telephone Number	:	541-296-2201
Fax Number	:	541-296-1237

Provider Business Practice Location Address
First Line	:	1805 E 19TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-3365
Country	:	US
Telephone Number	:	541-296-2201
Fax Number	:	541-296-1237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/09/2007

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