Provider Demographics
NPI:1255314381
Name:RASKIN, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:RASKIN
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:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-0986
Mailing Address - Country:US
Mailing Address - Phone:276-322-3342
Mailing Address - Fax:276-322-3342
Practice Address - Street 1:2000 LEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2020
Practice Address - Country:US
Practice Address - Phone:276-326-1215
Practice Address - Fax:276-326-1518
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010281472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A72140Medicare UPIN
VA723352Medicare ID - Type Unspecified