MEDICARE: JOHN A RICH 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	207R00000X	Internal Medicine Physician	MD426456	PA

General Provider Information

NPI Number	:	1790102945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A RICH MD

Provider Business Mailing Address
First Line	:	1505 RACE ST
Second Line	:	6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 RACE ST
Second Line	:	6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1119
Country	:	US
Telephone Number	:	215-906-6598
Fax Number	:

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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