Provider Demographics
NPI:1528031341
Name:REBECCA M. HANIGOSKY, D.O.
Entity Type:Organization
Organization Name:REBECCA M. HANIGOSKY, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-981-4960
Mailing Address - Street 1:480 N KERRWOOD DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5212
Mailing Address - Country:US
Mailing Address - Phone:724-981-4960
Mailing Address - Fax:724-982-4350
Practice Address - Street 1:480 N KERRWOOD DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5212
Practice Address - Country:US
Practice Address - Phone:724-981-4960
Practice Address - Fax:724-982-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008739L207V00000X
OH34005380H207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015217190007Medicaid
PA0015217190007Medicaid
PAG05966Medicare ID - Type Unspecified