1215036058 NPI number — RASO MEDICAL CENTER, PC

Table of content: (NPI 1215036058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215036058 NPI number — RASO MEDICAL CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RASO MEDICAL CENTER, PC
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:
DR DOMINICK J RASO MD
Provider Other Organization Name Type Code:
3
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:
1215036058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 N 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-258-9091
Provider Business Mailing Address Fax Number:
610-258-2992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 N 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-258-9091
Provider Business Practice Location Address Fax Number:
610-258-2992
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASO
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
610-258-9091

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2321000 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1412509 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DH1635 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 511930 . This is a "AETNA U.S. HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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