Provider Demographics
NPI:1700963337
Name:RICH, MICHAEL O (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:RICH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7181
Mailing Address - Fax:617-730-0004
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:FLOOR 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-7181
Practice Address - Fax:617-730-0004
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151205208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3153230Medicaid
A21611Medicare ID - Type Unspecified
MA3153230Medicaid