Provider Demographics
NPI:1639139850
Name:ANDALORO, REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ANDALORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 BOETTLER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9219
Mailing Address - Country:US
Mailing Address - Phone:330-899-0103
Mailing Address - Fax:330-899-0268
Practice Address - Street 1:1402 BOETTLER RD
Practice Address - Street 2:SUITE C
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9219
Practice Address - Country:US
Practice Address - Phone:330-899-0103
Practice Address - Fax:330-899-0268
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083313A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2485850Medicaid
OH2485850Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID #
I08566Medicare UPIN
OH4135572Medicare PIN