Basic Information
| Provider Information | |||||||||
| NPI: | 1467480350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAST | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD054210L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000257194 | 01 | PA | UNISON | OTHER | 000545636 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 14808 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 1046919 | 01 | PA | AMERIHEALTH MERCY | OTHER | P002760 | 01 | PA | GATEWAY | OTHER | 0739808000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 080100812 | 01 | PA | RAILROAD MEDICARE | OTHER | 1190741 | 01 | PA | AETNA | OTHER | 001491807 0008 | 05 | PA | MEDICAID | 50082755 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 54821 | 01 | PA | HEALTH AMERICA | OTHER |