Provider Demographics
NPI:1265407753
Name:RASEFSKE, JASON P (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:RASEFSKE
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 1:25 COLONY BLVD
Mailing Address - Street 2:URGI-CARE CENTER
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7971
Mailing Address - Country:US
Mailing Address - Phone:724-459-1700
Mailing Address - Fax:724-459-1702
Practice Address - Street 1:25 COLONY BLVD
Practice Address - Street 2:URGI-CARE CENTER
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7971
Practice Address - Country:US
Practice Address - Phone:724-459-1700
Practice Address - Fax:724-459-1702
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066175L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011684287Medicaid
PA002442PD9Medicare ID - Type Unspecified
PA011684287Medicaid