Healthcare Provider Details

I. General information

NPI: 1740278258
Provider Name (Legal Business Name): RAUL RODRIGUEZ-FEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 WALNUT ST
JOHNSTOWN PA
15901-1621
US

IV. Provider business mailing address

132 WALNUT ST
JOHNSTOWN PA
15901-1621
US

V. Phone/Fax

Practice location:
  • Phone: 814-536-7386
  • Fax: 814-536-7593
Mailing address:
  • Phone: 814-536-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD041428E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: