Provider Demographics
NPI:1700828951
Name:PRATT, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:PRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2605 WILLOW STREET PIKE N
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9510
Mailing Address - Country:US
Mailing Address - Phone:717-464-2838
Mailing Address - Fax:717-464-3812
Practice Address - Street 1:2605 WILLOW STREET PIKE N
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9510
Practice Address - Country:US
Practice Address - Phone:717-464-2838
Practice Address - Fax:717-464-3812
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021437E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000799173Medicaid
PAC31865Medicare UPIN