Lycoming Neurosurgical Associates, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD038209L Issued in PA

Legal business name

LYCOMING NEUROSURGICAL ASSOCIATES, INC

Practice address

904 Campbell St
Suite 104
Williamsport, PA 17701-3166

Phone

(570) 326-2035

Fax

(570) 326-9220

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Rodwan K Rajjoub, M.D.

Title

President

Phone

(570) 326-2035

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1992857395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 CAMPBELL ST",
            "address_2": "SUITE 104",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013166",
            "telephone_number": "570-326-2035",
            "fax_number": "570-326-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 CAMPBELL ST",
            "address_2": "SUITE 104",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013166",
            "telephone_number": "570-326-2035",
            "fax_number": "570-326-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING NEUROSURGICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "RAJJOUB",
        "authorized_official_first_name": "RODWAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-326-2035",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD038209L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR RODWAN RAJJOUB NPI",
            "identifier": "1528033651",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008460030003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; 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.