Provider Demographics
NPI:1740278258
Name:RODRIGUEZ-FEO, RAUL (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:RODRIGUEZ-FEO
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 1:132 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1621
Mailing Address - Country:US
Mailing Address - Phone:814-536-7386
Mailing Address - Fax:
Practice Address - Street 1:132 WALNUT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1621
Practice Address - Country:US
Practice Address - Phone:814-536-7386
Practice Address - Fax:814-536-7593
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041428E2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01174425Medicaid
D01810Medicare UPIN
PA01174425Medicaid