Provider Demographics
NPI:1457440463
Name:RICHES, MARCIE L (MD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:L
Last Name:RICHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DRIVE POB CB#7305
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7305
Mailing Address - Country:US
Mailing Address - Phone:919-962-4883
Mailing Address - Fax:919-966-6735
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-966-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47123207R00000X
FLME104501207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000866300Medicaid
MNHP42942OtherHEALTH PARTNERS
MN2154903OtherARAZ
MN36-00511OtherMEDICA CHOICE
MN711085OtherFAIRVIEW
MN132037OtherUCARE
MT0079169Medicaid
MN36-00013OtherMEDICA PRIMARY
MN1041329OtherPREFERRED ONE
MN36-00013OtherMEDICA PRIMARY
MN711085OtherFAIRVIEW
H08642Medicare UPIN
MN36-00511OtherMEDICA CHOICE