Provider Demographics
NPI:1538118047
Name:RAINEY, RALPH GARY (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:GARY
Last Name:RAINEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:965 BALTIMORE PIKE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3957
Mailing Address - Country:US
Mailing Address - Phone:610-543-2800
Mailing Address - Fax:610-328-3200
Practice Address - Street 1:965 BALTIMORE PIKE
Practice Address - Street 2:SUITEB4
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3957
Practice Address - Country:US
Practice Address - Phone:610-328-2800
Practice Address - Fax:610-328-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0S003151L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4293281OtherAETNA
PA091142Medicare PIN
4293281OtherAETNA