Provider Demographics
NPI:1669416517
Name:RAPPOLE, BERT W (MD)
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:W
Last Name:RAPPOLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-483-1183
Mailing Address - Fax:716-483-2445
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 170
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-483-1183
Practice Address - Fax:716-483-2445
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-01-28
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Provider Licenses
StateLicense IDTaxonomies
NY099765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482366Medicaid
PA000698887Medicaid
NY00482366Medicaid
NYB81106Medicare UPIN