Provider Demographics
NPI:1174524946
Name:ARREOLA, RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:ARREOLA
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:ONE LECOM PLACE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:5401 PEACH STREET
Practice Address - Street 2:SUITE 3600
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-868-2170
Practice Address - Fax:814-868-2108
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02495398OtherNY MEDICAL ASSISTANCE
PA1521644OtherGATEWAY
PA0018811600004Medicaid
PA304080OtherUPMC
OH2433763OtherOH MEDICAL ASSISTANCE
PAP00057889OtherRR MEDICARE
WV1068871OtherWEST VIRGINIA WORK COMP
PA1320956OtherBLUE SHIELD
PA1320956OtherBLUE SHIELD
PA304080OtherUPMC
PA304080OtherUPMC
PA1320956OtherBLUE SHIELD
PA145530OtherUNISON