Provider Demographics
NPI:1295805877
Name:RICH, MICHAEL A (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:RICH, M.D. AND ASSOCIATES, INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:304 15TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2523
Mailing Address - Country:US
Mailing Address - Phone:330-454-8700
Mailing Address - Fax:330-454-9836
Practice Address - Street 1:304 15TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2523
Practice Address - Country:US
Practice Address - Phone:330-454-8700
Practice Address - Fax:330-454-9836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH658772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0971033Medicaid
OHF53249Medicare UPIN
OH9291851Medicare ID - Type Unspecified