Basic Information
| Provider Information | |||||||||
| NPI: | 1366430258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8791 BARNES LAKE RD | ||||||||
| Address2: | |||||||||
| City: | IRWIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156423176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324084 | ||||||||
| FaxNumber: | 7248646837 | ||||||||
| Practice Location | |||||||||
| Address1: | 8791 BARNES LAKE RD | ||||||||
| Address2: | |||||||||
| City: | IRWIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156423176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248646834 | ||||||||
| FaxNumber: | 7248646837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35077080 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1804924000 | 01 | WV | MEDICAID | OTHER | 2203298 | 05 | OH | MEDICAID | 64033624 | 01 | KY | MEDICAID | OTHER |