Provider Demographics
NPI:1033103924
Name:RAHALL, LAWRENCE F (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:F
Last Name:RAHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 PORTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2719
Mailing Address - Country:US
Mailing Address - Phone:724-758-3393
Mailing Address - Fax:724-758-5689
Practice Address - Street 1:638 PORTERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2719
Practice Address - Country:US
Practice Address - Phone:724-758-3393
Practice Address - Fax:724-758-5689
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2016-01-05
Deactivation Date:2006-03-30
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PAOS004844L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE70818Medicare UPIN
PA066559Medicare ID - Type Unspecified14