Provider Demographics
NPI:1336354687
Name:RODGER W ALTHOFF MD PC
Entity Type:Organization
Organization Name:RODGER W ALTHOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-282-0809
Mailing Address - Street 1:99 W SUNBURY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4011
Mailing Address - Country:US
Mailing Address - Phone:724-282-0809
Mailing Address - Fax:724-282-0999
Practice Address - Street 1:99 W SUNBURY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4011
Practice Address - Country:US
Practice Address - Phone:724-282-0809
Practice Address - Fax:724-282-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1417906991OtherNPI
PA1530903OtherGATEWAY
PA548253OtherBLUES
PA0016483700003Medicaid
PA1417906991OtherNPI
PA548253OtherBLUES