Provider Demographics
NPI:1013998640
Name:RITCHEA, ROBERT MARK (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:RITCHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 RIVER CHASE DR
Mailing Address - Street 2:BLDG 200
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7425
Mailing Address - Country:US
Mailing Address - Phone:334-448-8007
Mailing Address - Fax:334-448-1669
Practice Address - Street 1:5009 RIVER CHASE DR
Practice Address - Street 2:BLDG. 200
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7425
Practice Address - Country:US
Practice Address - Phone:334-448-8007
Practice Address - Fax:334-448-1669
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033688207R00000X
AL00019887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDVFTMedicare PIN
E72670Medicare UPIN
AL5150872Medicare PIN