Provider Demographics
NPI:1265487623
Name:RAIKIN, STEVEN MARK (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:RAIKIN
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 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3763
Practice Address - Street 1:3300 TILLMAN DR FL 2
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2071
Practice Address - Country:US
Practice Address - Phone:267-339-3558
Practice Address - Fax:267-339-3763
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07108800207XX0004X
FLME152909207XX0004X
PAMD070216L207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2378279OtherAETNA
PA0559350000OtherIBC
NJ0803514000OtherIBC
2784525OtherCIGNA
PA2265820OtherAETNA
G85085Medicare UPIN
PA200037151Medicare PIN
PA2265820OtherAETNA
NJ039727PFCMedicare ID - Type Unspecified
NJ200043292Medicare PIN