Provider Demographics
NPI:1164455911
Name:OSTERER, RAYMOND HENRY (PA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:HENRY
Last Name:OSTERER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658
Mailing Address - Country:US
Mailing Address - Phone:828-464-7800
Mailing Address - Fax:
Practice Address - Street 1:2180 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3753
Practice Address - Country:US
Practice Address - Phone:828-464-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR77871Medicare UPIN
NC2751238BMedicare ID - Type Unspecified