Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0101045163 | VA |
NPI | 1073505152 |
---|---|
Provider Name | Jeffrey B Rich |
First Address | Norfolk, VA 23507-1904 |
Second Address | Norfolk, VA 23507-1904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E67284 | (02) | VA |