Provider Demographics
NPI:1467480350
Name:RAST, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RAST
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054210L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000257194OtherUNISON
PA000545636OtherHIGHMARK BLUE SHIELD
PA14808OtherGEISINGER HEALTH PLAN
PA1046919OtherAMERIHEALTH MERCY
PAP002760OtherGATEWAY
PA0739808000OtherINDEPENDENCE BLUE CROSS
PA080100812OtherRAILROAD MEDICARE
PA1190741OtherAETNA
PA001491807 0008Medicaid
PA50082755OtherCAPITAL BLUE CROSS
PA54821OtherHEALTH AMERICA
PA001491807 0008Medicaid
PA000000257194OtherUNISON