Provider Demographics
NPI:1003818659
Name:RAZZINO, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:RAZZINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POPLAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2205
Mailing Address - Country:US
Mailing Address - Phone:717-763-0510
Mailing Address - Fax:717-761-6081
Practice Address - Street 1:800 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2205
Practice Address - Country:US
Practice Address - Phone:717-763-0510
Practice Address - Fax:717-761-6081
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038799E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011552600003Medicaid
PA0011552600003Medicaid