Provider Demographics
NPI:1043292477
Name:KRAYNAK, RAYMOND J (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:KRAYNAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2106
Mailing Address - Country:US
Mailing Address - Phone:570-339-5754
Mailing Address - Fax:570-339-3820
Practice Address - Street 1:28 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2106
Practice Address - Country:US
Practice Address - Phone:570-339-5754
Practice Address - Fax:570-339-3820
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS5323L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009560140002Medicaid
PA124876OtherPTAN
PA0009560140002Medicaid
PAE13886Medicare UPIN