Provider Demographics
NPI:1114024429
Name:RASZEWSKI, RICHARD LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEO
Last Name:RASZEWSKI
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 1:620 WARRENDALE ROAD
Mailing Address - Street 2:TREESDALE MARKET SQUARE
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8062
Mailing Address - Country:US
Mailing Address - Phone:724-940-3223
Mailing Address - Fax:724-940-3224
Practice Address - Street 1:620 WARRENDALE RD
Practice Address - Street 2:TREESDALE MARKET SQUARE
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8062
Practice Address - Country:US
Practice Address - Phone:724-940-3223
Practice Address - Fax:724-940-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059267L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG30370Medicare UPIN