1558300558 NPI number — DARREN L RATH RPA-C

Table of content: DARREN L RATH RPA-C (NPI 1558300558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558300558 NPI number — DARREN L RATH RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATH
Provider First Name:
DARREN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
M

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:
1558300558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COLLEGE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-626-9900
Provider Business Mailing Address Fax Number:
716-629-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COLLEGE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-626-9900
Provider Business Practice Location Address Fax Number:
716-629-9100
Provider Enumeration Date:
06/05/2006

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: 363AM0700X , with the licence number:  005948-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 005948-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02343093 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".