1174524946 NPI number — RODOLFO ARREOLA MD

Table of content: RODOLFO ARREOLA MD (NPI 1174524946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174524946 NPI number — RODOLFO ARREOLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARREOLA
Provider First Name:
RODOLFO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1174524946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE LECOM PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16505-2571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
814-868-2522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 PEACH STREET
Provider Second Line Business Practice Location Address:
SUITE 3600
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-868-2170
Provider Business Practice Location Address Fax Number:
814-868-2108
Provider Enumeration Date:
08/03/2005

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: 208600000X , with the licence number:  MD417031 , 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: 02495398 . This is a "NY MEDICAL ASSISTANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1521644 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018811600004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304080 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2433763 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00057889 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1068871 . This is a "WEST VIRGINIA WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1320956 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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