Provider Demographics
NPI:1073665253
Name:RAYNER, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RAYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:333 N. OXFORD VLY RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-547-1386
Mailing Address - Fax:215-943-1304
Practice Address - Street 1:333 N. OXFORD VLY RD
Practice Address - Street 2:SUITE 503
Practice Address - City:FAIRLESS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-547-1386
Practice Address - Fax:215-943-1304
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021530E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2084727OtherAETNA
PA0009533620004Medicaid
PA0052144000OtherKEYSTONE HPE
PA2084727OtherAETNA
PA413529Medicare ID - Type Unspecified