1588761639 NPI number — DAVID MICHAEL RAEZER MD

Table of content: NANCY KALINOWSKI (NPI 1285804849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588761639 NPI number — DAVID MICHAEL RAEZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAEZER
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INC
Provider Other First Name:
USURG
Provider Other Middle Name:
ASSOCIATES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588761639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1999 SPROUL RD
Provider Second Line Business Mailing Address:
SUITES 12 AND 16
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-534-6100
Provider Business Mailing Address Fax Number:
610-534-6104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITES 12 AND 16
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-534-6100
Provider Business Practice Location Address Fax Number:
610-534-6104
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD030565L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0031117000 . This is a "PERSONAL CHOICE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0031117000 . This is a "AMERIHEALTH ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 146871 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P0034748 . This is a "TRICARE PROVIDER ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00252734 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 025027 . This is a "BLAIR MILL ADMINISTRATORS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12459 . This is a "ELDER HEALTH ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 36158333 . This is a "MULTIPLAN ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CL6874 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007379020002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007380240001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0031117000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0073802406 . This is a "AMERICHOICE ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1202110002 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4088087 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DES178 . This is a "OXFORD HEALTH PLAN ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2327902 . This is a "NJ MEDICAID PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com