Healthcare Provider Details

I. General information

NPI: 1649255506
Provider Name (Legal Business Name): PATRICK A RICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 MASSILLON RD STE 250
UNIONTOWN OH
44685-7854
US

IV. Provider business mailing address

PO BOX 1239
TROY MI
48099-1239
US

V. Phone/Fax

Practice location:
  • Phone: 330-896-5651
  • Fax:
Mailing address:
  • Phone: 248-824-6600
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: