Provider Demographics
NPI:1316285216
Name:DU SSOLLAE, RAE K (DOM, LAC, DIPLO OM)
Entity type:Individual
Prefix:DR
First Name:RAE
Middle Name:K
Last Name:DU SSOLLAE
Suffix:
Gender:F
Credentials:DOM, LAC, DIPLO OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 DICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEN AVON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-1818
Mailing Address - Country:US
Mailing Address - Phone:412-680-2120
Mailing Address - Fax:
Practice Address - Street 1:422 DICKSON AVE
Practice Address - Street 2:
Practice Address - City:BEN AVON
Practice Address - State:PA
Practice Address - Zip Code:15202-1818
Practice Address - Country:US
Practice Address - Phone:412-680-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000053171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist