1609073428 NPI number — RACHEL FASSON ESPOSITO, DO, LTD

Table of content: (NPI 1609073428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609073428 NPI number — RACHEL FASSON ESPOSITO, DO, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RACHEL FASSON ESPOSITO, DO, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1609073428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 S HERMITAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-347-0861
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 BESSEMER RD
Provider Second Line Business Practice Location Address:
SUITE 203-204
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-9122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-628-5100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESPOSITO
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
FASSON
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
724-628-5100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS012524 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1770577793 . This is a "TYPE I PROVIDER NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OS012524 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019369860001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1969747 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".