Provider Demographics
NPI:1558300558
Name:RATH, DARREN L (RPA-C)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:L
Last Name:RATH
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-626-9900
Mailing Address - Fax:716-629-9100
Practice Address - Street 1:100 COLLEGE PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-626-9900
Practice Address - Fax:716-629-9100
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005948-1363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02343093Medicaid
NYDD6550Medicare ID - Type Unspecified
NYS66572Medicare UPIN