Provider Demographics
NPI:1871921197
Name:RANALLI, GREGORY F (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:RANALLI
Suffix:
Gender:M
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 1:230 WEST WASHINGTON SQUARE
Mailing Address - Street 2:5TH FLOOR, FARM JOURNAL BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:215-829-2220
Mailing Address - Fax:
Practice Address - Street 1:230 WEST WASHINGTON SQUARE
Practice Address - Street 2:5TH FLOOR, FARM JOURNAL BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:215-829-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056563363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical