Provider Demographics
NPI:1528060217
Name:RICH, PAUL A (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:RICH
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 1:5170 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1022
Mailing Address - Country:US
Mailing Address - Phone:330-759-2511
Mailing Address - Fax:330-759-5476
Practice Address - Street 1:5170 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1022
Practice Address - Country:US
Practice Address - Phone:330-759-2511
Practice Address - Fax:330-759-5476
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2012-12-13
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OH35075844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2121555Medicaid
OH0870595Medicare PIN
OH2121555Medicaid