Provider Demographics
NPI:1477727162
Name:SMITH, RAYMOND L (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:2603 KEISER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3341
Practice Address - Country:US
Practice Address - Phone:484-628-3939
Practice Address - Fax:484-628-3940
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD009512E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102124609Medicaid
PA144882Medicare PIN