Provider Demographics
NPI:1538305834
Name:RAFFERTY, BERNARD JOHN JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:JOHN
Last Name:RAFFERTY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2875
Mailing Address - Fax:717-339-2792
Practice Address - Street 1:40 V TWIN DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7878
Practice Address - Country:US
Practice Address - Phone:717-339-2875
Practice Address - Fax:717-339-2792
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00211600363A00000X
PAMA053741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1618946OtherGATEWAY MEDICARE ASSURED
PA2884978OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
PA2884978OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
PA276015Medicare UPIN
PA276015FLTMedicare PIN