Provider Demographics
NPI:1972017101
Name:RINCHUSE, DEREK LOGAN (MS, MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LOGAN
Last Name:RINCHUSE
Suffix:
Gender:M
Credentials:MS, MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-4484
Mailing Address - Fax:412-578-3536
Practice Address - Street 1:4815 LIBERTY AVE STE 322
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-4484
Practice Address - Fax:412-578-3536
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103443211Medicaid