Healthcare Provider Details

I. General information

NPI: 1023022183
Provider Name (Legal Business Name): JUSTIN T RICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 TOWN CENTRE DR STE 110
BROADVIEW HTS OH
44147-4046
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-6630
  • Fax: 440-526-1487
Mailing address:
  • Phone: 440-526-6630
  • Fax: 440-526-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-088305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: