Healthcare Provider Details

I. General information

NPI: 1265407753
Provider Name (Legal Business Name): JASON P RASEFSKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COLONY BLVD URGI-CARE CENTER
BLAIRSVILLE PA
15717-7971
US

IV. Provider business mailing address

25 COLONY BLVD URGI-CARE CENTER
BLAIRSVILLE PA
15717-7971
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-1700
  • Fax: 724-459-1702
Mailing address:
  • Phone: 724-459-1700
  • Fax: 724-459-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD066175L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: