Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP009664 | PA |
NPI | 1003099847 |
---|---|
Provider Name | Mr. Timothy J. Rausch |
First Address | Pittsburgh, PA 15212-4756 |
Second Address | Pittsburgh, PA 15212-4756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2007 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102219159 | (05) | PA |
11893758 | CAQH (01) |