Provider Demographics
NPI:1033110648
Name:OTOOLE, RAYMOND C (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:OTOOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1370 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2839
Mailing Address - Country:US
Mailing Address - Phone:412-221-0160
Mailing Address - Fax:412-221-0860
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:SUITE 107
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2839
Practice Address - Country:US
Practice Address - Phone:412-221-0160
Practice Address - Fax:412-221-0860
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061104L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016494840003Medicaid