MEDICARE: MARK ALAN RICHARDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4301085615	MI
2	2085R0202X	Diagnostic Radiology Physician	35.097236	OH

General Provider Information

NPI Number	:	1104031483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN RICHARDS MD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 W MARKET ST
Second Line	:	SUITE 110
City	:	AKRON
State	:	OH
Zip	:	44313-4432
Country	:	US
Telephone Number	:	330-867-7274
Fax Number	:	330-867-2495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	10/12/2021

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