Provider Demographics
NPI:1023022183
Name:RICH, JUSTIN T (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:T
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-526-6630
Mailing Address - Fax:440-526-1487
Practice Address - Street 1:9075 TOWN CENTRE DR STE 110
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4046
Practice Address - Country:US
Practice Address - Phone:440-526-6630
Practice Address - Fax:440-526-1487
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680906Medicaid
OHI59500Medicare UPIN