Provider Demographics
NPI:1346349099
Name:NAZZARO, RALPH E (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:E
Last Name:NAZZARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-2516
Mailing Address - Country:US
Mailing Address - Phone:814-827-6929
Mailing Address - Fax:
Practice Address - Street 1:150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1724
Practice Address - Country:US
Practice Address - Phone:814-827-3400
Practice Address - Fax:814-827-3556
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018974E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017303550001Medicaid
PA1017303550001Medicaid
PAB35433Medicare UPIN