Healthcare Provider Details

I. General information

NPI: 1871570622
Provider Name (Legal Business Name): ALLENSIDE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 MANCHESTER RD
AKRON OH
44314
US

IV. Provider business mailing address

2417 MANCHESTER RD
AKRON OH
44314
US

V. Phone/Fax

Practice location:
  • Phone: 330-848-3377
  • Fax: 330-848-3325
Mailing address:
  • Phone: 330-848-3377
  • Fax: 330-848-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004672
License Number StateOH

VIII. Authorized Official

Name: DR. DEAN PATRICK RICH
Title or Position: PHYSICIAN
Credential: DO
Phone: 330-848-3377