Provider Demographics
NPI:1659313732
Name:RITCH, MARK L (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:RITCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BELCHER RD S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3321
Mailing Address - Country:US
Mailing Address - Phone:727-209-2662
Mailing Address - Fax:727-209-2665
Practice Address - Street 1:1000 BELCHER RD S
Practice Address - Street 2:SUITE 6
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3321
Practice Address - Country:US
Practice Address - Phone:727-209-2662
Practice Address - Fax:727-209-2665
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00065662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373750100Medicaid
F61938Medicare UPIN
FL373750100Medicaid