Individual
AUDREY RICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
549 FAIR ST, BLOOMSBURG, PA 17815-1419
(505) 400-8556
Mailing address
211 FAIR ST, BLOOMSBURG, PA 17815-1413
(505) 400-8556
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MT224438
PA
208D00000X
General Practice Physician
Primary
MT224438
PA
363AS0400X
Surgical Physician Assistant
PA2014-0023
NM
Other
Enumeration date
07/09/2014
Last updated
07/12/2021
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