Justin David Rado, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

USA Meddac
11050 Mount Belvedere Blvd
Fort Drum, NY 13602

Phone

(315) 772-6214

NPI assigned

Jan 10, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1124899026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 N MAIN ST",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122109",
            "telephone_number": "270-348-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USA MEDDAC",
            "address_2": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-772-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADO",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita Lynn Pruitt, DDS
• Lorraine Jaconna Pugh, LCSW
• Jin Pyun, M.D.
• Serajus Salekin Quaderi, DDS
• Julia Radko
• Mahbuba Rahman, DDS
• Colette Rajner
• Mehmet Fatih Ramazanoglu, MD
• Sue Randall-Schneebeli, DENTAL ASSISTANTEFDA
• Christina Marie Rath, PA-C

• Physician Assistant in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.