Provider Demographics
NPI:1033187919
Name:RAINVILLE, CRYSTAL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:L
Last Name:RAINVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE PEARL STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2865
Mailing Address - Country:US
Mailing Address - Phone:508-894-8577
Mailing Address - Fax:508-894-8578
Practice Address - Street 1:ONE PEARL STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2865
Practice Address - Country:US
Practice Address - Phone:508-894-8577
Practice Address - Fax:508-894-8578
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3193195Medicaid
G93744Medicare UPIN
MA3193195Medicaid