Provider Demographics
NPI:1700037496
Name:RICH, MARVA B (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARVA
Middle Name:B
Last Name:RICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:265 WOODGREEN DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-4168
Mailing Address - Country:US
Mailing Address - Phone:910-944-1175
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER ROAD
Practice Address - Street 2:PO DRAWER B, HWY 421
Practice Address - City:MAMERS
Practice Address - State:NC
Practice Address - Zip Code:27552
Practice Address - Country:US
Practice Address - Phone:910-893-5402
Practice Address - Fax:910-893-2567
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00275363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical