Healthcare Provider Details

I. General information

NPI: 1871639138
Provider Name (Legal Business Name): RAINONE GENERAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHUYLKILL MEDICAL PLZ SUITE 204
POTTSVILLE PA
17901-3663
US

IV. Provider business mailing address

100 SCHUYLKILL MEDICAL PLZ SUITE 204
POTTSVILLE PA
17901-3663
US

V. Phone/Fax

Practice location:
  • Phone: 570-621-5740
  • Fax: 570-621-6367
Mailing address:
  • Phone: 570-621-5740
  • Fax: 570-621-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARYLOU RAINONE
Title or Position: OWNER
Credential: DO
Phone: 570-621-5740