Provider Demographics
NPI:1568453702
Name:MARCH, RICHARD ALLEN (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:MARCH
Suffix:
Gender:M
Credentials:PA
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 75
Mailing Address - Street 2:17144 HWY 84
Mailing Address - City:LOS OJOS
Mailing Address - State:NM
Mailing Address - Zip Code:87551-0075
Mailing Address - Country:US
Mailing Address - Phone:505-588-0010
Mailing Address - Fax:
Practice Address - Street 1:12000 STONE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:97528-3291
Practice Address - Country:US
Practice Address - Phone:505-759-3291
Practice Address - Fax:505-759-7294
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K3526Medicaid
NMHSZ196OtherMEDICARE PART B
NMHSZ196OtherMEDICARE PART B
NM8HE216Medicare ID - Type Unspecified
NMR13189Medicare UPIN