Provider Demographics
NPI:1295983963
Name:RAUSCH, ASHLEIGH L (RPA-C)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:L
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:L
Other - Last Name:MATTESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 PORTLAND AVE UPPR 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2713
Mailing Address - Country:US
Mailing Address - Phone:315-272-8721
Mailing Address - Fax:
Practice Address - Street 1:1255 PORTLAND AVE UPPR 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2713
Practice Address - Country:US
Practice Address - Phone:315-272-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400003033Medicare PIN