Provider Demographics
NPI:1790773745
Name:RAHNER, DOUGLAS ANDREW
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:RAHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SOUTH WEST STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:20 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:NY
Practice Address - Zip Code:13803
Practice Address - Country:US
Practice Address - Phone:607-849-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673729Medicaid
NYI35959Medicare ID - Type Unspecified
NY02673729Medicaid