Provider Demographics
NPI:1154394732
Name:ROHL, BERNEDETTE LYNNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BERNEDETTE
Middle Name:LYNNE
Last Name:ROHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER WAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2255
Practice Address - Country:US
Practice Address - Phone:607-973-8600
Practice Address - Fax:607-962-5102
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005825-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970020009OtherRR MEDICARE PIN
NY01680726Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYCC8362OtherRR MEDICARE GROUP
S26184Medicare UPIN