Provider Demographics
NPI:1053401133
Name:RHOADES, DENNIS W (DO)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:RHOADES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:757 JOHNSONBURG RD
Mailing Address - Street 2:GROUND FLOOR REHAB BUILDING
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3488
Mailing Address - Country:US
Mailing Address - Phone:814-834-6300
Mailing Address - Fax:814-781-1321
Practice Address - Street 1:757 JOHNSONBURG RD
Practice Address - Street 2:GROUND FLOOR REHAB BUILDING
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3488
Practice Address - Country:US
Practice Address - Phone:814-834-6300
Practice Address - Fax:814-781-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005083-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00964428Medicaid
C28546Medicare UPIN
055080Medicare ID - Type Unspecified