Provider Demographics
NPI:1366492480
Name:RASTRELLI, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:RASTRELLI
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 1:27 MONTEBELLO RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:27 MONTEBELLO RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1236
Practice Address - Country:US
Practice Address - Phone:719-545-1530
Practice Address - Fax:719-545-2899
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36999207W00000X
NM2003-0594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM343327601Medicaid
CO0452890001OtherMEDICARE DMERC
CORAK2189OtherBCBS NORTH DAKOTA
CO01369990Medicaid
COCO6999OtherEYE MED EYECARE
CT920717020820OtherEYE SPECIALISTS
COK2189OtherFEDERAL BCBS
CONM009J51OtherBCBS NM
COK2189OtherANTHEM
CO180043214OtherRAILROAD MEDICARE
CO343327601OtherNM MEDICARE
CO0452890001OtherMEDICARE DMERC
CO449808Medicare ID - Type Unspecified