Provider Demographics
NPI:1851370811
Name:RAPELLO, T DONALD (MD)
Entity Type:Individual
Prefix:
First Name:T
Middle Name:DONALD
Last Name:RAPELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 BIENIEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT JOHNSON
Mailing Address - State:NY
Mailing Address - Zip Code:12070-1657
Mailing Address - Country:US
Mailing Address - Phone:518-842-5757
Mailing Address - Fax:518-842-5757
Practice Address - Street 1:168 BIENIEK DRIVE
Practice Address - Street 2:
Practice Address - City:FORT JOHNSON
Practice Address - State:NY
Practice Address - Zip Code:12070-1657
Practice Address - Country:US
Practice Address - Phone:518-842-5757
Practice Address - Fax:518-842-5757
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107751207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527591Medicaid
NYAR4338097OtherDEA
NYAR4338097OtherDEA
B80830Medicare UPIN