Provider Demographics
NPI:1871590844
Name:RICH, JONATHAN DAVID (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:RICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SAINT PAUL ST STE 603
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-333-9680
Mailing Address - Fax:410-332-9669
Practice Address - Street 1:301 ST. PAUL PLACE
Practice Address - Street 2:SUITE 603 PROF OFFICE BLDG
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-332-9680
Practice Address - Fax:410-332-9669
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0062638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129XXMedicaid
NC2401211Medicare ID - Type Unspecified
NC89129XXMedicaid