Provider Demographics
NPI:1851703433
Name:RICH, ROXANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
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 1:1132 NATALIE AVE S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9645
Mailing Address - Country:US
Mailing Address - Phone:541-350-9772
Mailing Address - Fax:
Practice Address - Street 1:891 23RD ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1793
Practice Address - Country:US
Practice Address - Phone:503-364-2181
Practice Address - Fax:503-364-0364
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD181830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty