1770876401 NPI number — ANGEL Q. RAPOSAS, MD, PC

Table of content: (NPI 1770876401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770876401 NPI number — ANGEL Q. RAPOSAS, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL Q. RAPOSAS, MD, 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:
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:
1770876401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3552 WOODSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648-5258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-693-1024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HOWARD AVE
Provider Second Line Business Practice Location Address:
SUITE D101
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-941-3005
Provider Business Practice Location Address Fax Number:
814-941-3445
Provider Enumeration Date:
05/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RAPOSAS
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
QUIANO
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
814-693-1024

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD059783L , 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: 040084K16 . This is a "MEDICARE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018116200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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