Provider Demographics
NPI:1548206980
Name:RICH, DEBORAH ARNETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ARNETTA
Last Name:RICH
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:PO BOX 2112
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-2112
Mailing Address - Country:US
Mailing Address - Phone:703-791-3288
Mailing Address - Fax:703-794-9987
Practice Address - Street 1:12307 CHARLES LACEY DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8837
Practice Address - Country:US
Practice Address - Phone:703-791-3288
Practice Address - Fax:703-794-9987
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052792207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W566501Medicare PIN
G20162Medicare UPIN