Provider Demographics
NPI:1295822203
Name:HARASTY, ROBERT (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:HARASTY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 TRANSPORTATION DR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-2849
Mailing Address - Country:US
Mailing Address - Phone:440-329-2800
Mailing Address - Fax:
Practice Address - Street 1:5001 TRANSPORTATION DR
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-2849
Practice Address - Country:US
Practice Address - Phone:440-329-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002321363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00709959OtherRAILROAD MEDICARE
PA32031Medicare PIN
OHP00709959OtherRAILROAD MEDICARE
PA80641Medicare PIN