Provider Demographics
NPI:1932117157
Name:RAINIERI, JOHN J (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RAINIERI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24723 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2526
Mailing Address - Country:US
Mailing Address - Phone:440-892-1440
Mailing Address - Fax:440-892-4709
Practice Address - Street 1:24723 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2526
Practice Address - Country:US
Practice Address - Phone:440-892-1440
Practice Address - Fax:440-892-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-0524363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRAPA14991Medicare ID - Type Unspecified
OHS99047Medicare UPIN