Healthcare Provider Details

I. General information

NPI: 1205386430
Provider Name (Legal Business Name): ANTHONY RAYMOND RAINERI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUNDY STREET
WILKES BARRE PA
18702-6830
US

IV. Provider business mailing address

150 MUNDY STREET
WILKES BARRE PA
18702-6830
US

V. Phone/Fax

Practice location:
  • Phone: 570-829-0031
  • Fax: 570-802-0104
Mailing address:
  • Phone: 570-829-0031
  • Fax: 570-802-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058585
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: