=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275853376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY EVELYN RICH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2010
-----------------------------------------------------
Last Update Date | 07/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 KUHL AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-841-8933
-----------------------------------------------------
Fax | 321-843-6219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 KUHL AVENUE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-843-6219
-----------------------------------------------------
Fax | 321-843-6219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | ME 118687
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | ME 118687
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------