Provider Demographics
NPI:1366430258
Name:RICH, DAVID HOWARD JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
Last Name:RICH
Suffix:JR
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 1:8791 BARNES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3176
Mailing Address - Country:US
Mailing Address - Phone:724-832-4084
Mailing Address - Fax:724-864-6837
Practice Address - Street 1:8791 BARNES LAKE RD
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3176
Practice Address - Country:US
Practice Address - Phone:724-864-6834
Practice Address - Fax:724-864-6837
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1804924000OtherMEDICAID
OH2203298Medicaid
KY64033624OtherMEDICAID
KY64033624OtherMEDICAID
OHRI4053721Medicare ID - Type Unspecified