Provider Demographics
NPI:1811958499
Name:RAUCH, DOUGLAS RICHARD
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RICHARD
Last Name:RAUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3228
Mailing Address - Country:US
Mailing Address - Phone:724-981-7557
Mailing Address - Fax:
Practice Address - Street 1:2151 SHENANGO VALLEY FWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2586
Practice Address - Country:US
Practice Address - Phone:724-981-5440
Practice Address - Fax:724-981-5315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0033007-L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039400OtherGATEWAY
PA0606910Medicaid
PA33251384837001OtherANTHEM
PA63682OtherMEDPLUS
PA93110OtherHEALTHAMERICA
PA201228OtherUPMC
PARA256897OtherKEYSTONE/SELECTBLUE
PARA166848Medicare ID - Type Unspecified
PA1039400OtherGATEWAY