Provider Demographics
NPI:1851360085
Name:RAPP, DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:RAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:22 RED JACKET STREET
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0499
Mailing Address - Country:US
Mailing Address - Phone:585-335-5200
Mailing Address - Fax:585-335-5037
Practice Address - Street 1:22 RED JACKET ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9502
Practice Address - Country:US
Practice Address - Phone:585-335-5200
Practice Address - Fax:585-335-5037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1507952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01058328Medicaid
NY01058328Medicaid