Provider Demographics
NPI:1093770885
Name:RAYNER, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:RAYNER
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 1:49 PRINCE STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3113
Mailing Address - Country:US
Mailing Address - Phone:717-901-3440
Mailing Address - Fax:717-901-3447
Practice Address - Street 1:49 PRINCE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3113
Practice Address - Country:US
Practice Address - Phone:717-901-3440
Practice Address - Fax:717-901-3447
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045812L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1225278922OtherNPI TYPE 2
PA001517574Medicaid
PA001517574 0006OtherMEDICAID - NYES ROAD
PA001517574Medicaid
PA001517574 0006OtherMEDICAID - NYES ROAD