Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | OS014492 | PA |
Y | 207Q00000X | Family Doctor | OS014492 | PA |
NPI | 1003896804 |
---|---|
Provider Name | Dr. Terry Paul Rast |
First Address | Camp Hill, PA 17011-1708 |
Second Address | Camp Hill, PA 17011-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 03/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A67550 | (02) |