Provider Demographics
NPI:1194730978
Name:RIFE, LARA L (PA-C)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:L
Last Name:RIFE
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:120 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-263-1220
Practice Address - Fax:717-263-6255
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052574363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052574OtherLICENSE
PA103150363Medicaid
PAP00841805OtherRAILROAD MEDICARE
PA50070685OtherCAPITAL BLUE CROSS
PA6622487OtherAETNA HMO
PA867633OtherMEDICARE GROUP #
PA9323234OtherAETNA NON HMO
PA9323234OtherAETNA NON HMO
PAMA052574OtherLICENSE