Individual
BRIAN LARRY RISAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
201 STATE ST, ERIE, PA 16550-0002
(814) 877-6139
(814) 877-6093
Mailing address
201 STATE ST, ERIE, PA 16550-0002
(814) 877-6139
(814) 877-6093
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS009354L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025185301
UNIVERA
NY
05
—
0018025310001
—
PA
01
—
02083085
NY MEDICAID
NY
01
—
1068836
WEST VIRGINIA WORK COMP
WV
01
—
108059
UNISON
PA
01
—
1514333
GATEWAY
PA
01
—
212665
UPMC
PA
01
—
2219727
OH MEDICAID
OH
01
—
2545956
AETNA
PA
01
—
436535
BLUE SHIELD
PA
01
—
930092901
RR MEDICARE
PA
Enumeration date
07/20/2005
Last updated
03/28/2013
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