Provider Demographics
NPI:1457347403
Name:PARE, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:PARE
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 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-475-0123
Mailing Address - Fax:770-442-9526
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4946
Practice Address - Country:US
Practice Address - Phone:770-475-0123
Practice Address - Fax:770-442-9526
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034918207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF824341Medicare UPIN
GA18BDCTPMedicare ID - Type UnspecifiedMEDICARE NO.