Provider Demographics
NPI:1710175336
Name:TORZONE, RAELYNN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:RAELYNN
Middle Name:
Last Name:TORZONE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:RAELYNN
Other - Middle Name:
Other - Last Name:KILLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1071 MD RT 3 N STE 101
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1784
Mailing Address - Country:US
Mailing Address - Phone:410-721-2333
Mailing Address - Fax:410-721-1207
Practice Address - Street 1:1071 MD RT 3 N STE 101
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1784
Practice Address - Country:US
Practice Address - Phone:410-721-2333
Practice Address - Fax:410-721-1207
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012122-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02957688Medicaid
NY02957688Medicaid
NYJ400083536Medicare PIN
NYPA2114Medicare PIN