Basic Information
| Provider Information | |||||||||
| NPI: | 1720081003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAPP | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2027 PULASKI HWY | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438436262 | ||||||||
| FaxNumber: | 4438436264 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 PULASKI HWY | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438436262 | ||||||||
| FaxNumber: | 4438436264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0054756 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6216720 | 01 | MD | CIGNA | OTHER | 820706-01 | 01 | BCBS POS | OTHER | 875475 | 01 | MDIPA/OPTIMUM CHOICE | OTHER | 282100100 | 05 | MD | MEDICAID |