Provider Demographics
NPI:1366443301
Name:RICHLAND PEDIATRICS INC
Entity Type:Organization
Organization Name:RICHLAND PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MDFAAP
Authorized Official - Phone:419-522-5454
Mailing Address - Street 1:120 STURGES AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903
Mailing Address - Country:US
Mailing Address - Phone:419-522-5454
Mailing Address - Fax:419-522-2981
Practice Address - Street 1:120 STURGES AVE
Practice Address - Street 2:STE 1
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903
Practice Address - Country:US
Practice Address - Phone:419-522-5454
Practice Address - Fax:419-522-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042404S208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300512Medicaid
OH2300512Medicaid
OH363836Medicare ID - Type Unspecified