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General NPI Number Information
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NPI Number | 1124224100
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Entity Type | Individual
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Provider Name | JEREMY NIELSEN RICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | BAACH, 121 CSH OTOLARYNGOLOGY SECTION
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City | APO
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State | AP
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Zip | 96205
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Country | US
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Telephone | 315-737-1285
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 15244 BOX 783
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City | APO
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State | AP
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Zip | 96205-5244
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Country | US
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Telephone | 315-737-1288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101245147
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License Number State | VA
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