=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659531366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD G. OLARSCH, DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2008
-----------------------------------------------------
Last Update Date | 11/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4211 PACIFIC AVE
-----------------------------------------------------
City | WILDWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08260-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-522-0727
-----------------------------------------------------
Fax | 609-522-2163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 147
-----------------------------------------------------
City | WILDWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08260-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-522-0727
-----------------------------------------------------
Fax | 609-522-2163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. RICHARD G OLARSCH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 609-522-0727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MB072240
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------