Provider Demographics
NPI:1447216247
Name:STANTONS, RAYMOND TERRANCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:TERRANCE
Last Name:STANTONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 US HIGHWAY 522
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9712
Mailing Address - Country:US
Mailing Address - Phone:570-374-0966
Mailing Address - Fax:
Practice Address - Street 1:880 US HIGHWAY 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9712
Practice Address - Country:US
Practice Address - Phone:570-374-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC 002013-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
94016Medicare ID - Type Unspecified
PAT28472Medicare UPIN