Provider Demographics
NPI:1407111404
Name:RIGANATI, KYLE PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PATRICK
Last Name:RIGANATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:517 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LYKENS
Practice Address - State:PA
Practice Address - Zip Code:17048-1520
Practice Address - Country:US
Practice Address - Phone:717-453-1073
Practice Address - Fax:717-453-8292
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS017226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030524150001Medicaid
PA1030524150001Medicaid