Provider Demographics
NPI:1457348179
Name:RAINONE, MARYLOU (DO)
Entity type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:
Last Name:RAINONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:STE 204
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3636
Practice Address - Country:US
Practice Address - Phone:570-621-5740
Practice Address - Fax:570-621-6367
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007230L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023056870001Medicaid
F86633Medicare UPIN
PA1023056870001Medicaid