Provider Demographics
NPI:1245218262
Name:RAWA, RANDALL S (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:RAWA
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:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-0990
Mailing Address - Country:US
Mailing Address - Phone:724-234-3581
Mailing Address - Fax:
Practice Address - Street 1:102 TECHNOLOGY DR STE 130
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1784
Practice Address - Country:US
Practice Address - Phone:724-234-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064603L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016972850020Medicaid
PAG72298Medicare UPIN
PA010532PDHMedicare PIN