Healthcare Provider Details

I. General information

NPI: 1306869961
Provider Name (Legal Business Name): MARK ANTHONY RAPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR DEPARTMENT OF PSYCHIATRY
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8338
  • Fax: 717-531-6491
Mailing address:
  • Phone: 315-464-3265
  • Fax: 315-464-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD430685
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD430685
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD430685
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME94175
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number222997
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1018544140001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier02319895
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier29407
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBLUE CROSS BLUE SHIELD
# 4
Identifier273667500
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: