Provider Demographics
NPI:1629027388
Name:COLON RECTAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:COLON RECTAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:RAKHMANINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-788-0840
Mailing Address - Street 1:1255 S. CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:484-788-0852
Mailing Address - Fax:610-435-5003
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3900
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-402-1095
Practice Address - Fax:610-435-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0827441000OtherKEYSTONE EAST
PA1514773OtherGATEWAY HEALTH PLAN
PA796986OtherHIGHMARK BLUE SHIELD
PA02352400OtherCAPITAL BLUE CROSS
PA619529OtherAETNA HMO
PA235HOtherGEISINGER HEALTH PLAN
PADA9831OtherRAILROAD MEDICARE
PA0827441000OtherAMERIHEALTH (IBC)
PA1062660OtherAMERIHEALTH MERCY
PA796986OtherKEYSTONE CENTRAL
PA796986OtherOXFORD HEALTH PLAN
PA152887OtherTHREE RIVERS/UNISON
PA619529OtherAETNA HMO