Provider Demographics
NPI:1114927365
Name:LANCIANO, RACHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:LANCIANO
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 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034807E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011451290004Medicaid
PA0000124213604OtherUNITED HEALTHCARE
PA711705OtherCIGNA
PA0055583OtherAETNA USHC
PA0092209000OtherKEYSTONE HEALTH PLAN EAST
PA201041OtherPA BCBS
PA0114512901OtherAMERICHOICE
PA0092209000OtherKEYSTONE HEALTH PLAN EAST
PAE60890Medicare UPIN
PA201041LSAMedicare ID - Type Unspecified