1154394732 NPI number — MRS. BERNEDETTE LYNNE ROHL PA-C

Table of content: MRS. BERNEDETTE LYNNE ROHL PA-C (NPI 1154394732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154394732 NPI number — MRS. BERNEDETTE LYNNE ROHL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHL
Provider First Name:
BERNEDETTE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154394732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GUTHRIE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18840-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-888-5858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CENTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14830-2255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-973-8600
Provider Business Practice Location Address Fax Number:
607-962-5102
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  005825-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970020009 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01680726 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8362 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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