Provider Demographics
NPI:1528182003
Name:PIERORAZIO, PHILLIP MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MARTIN
Last Name:PIERORAZIO
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 1:3737 MARKET ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5544
Mailing Address - Country:US
Mailing Address - Phone:215-662-8699
Mailing Address - Fax:215-243-4649
Practice Address - Street 1:3737 MARKET ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5544
Practice Address - Country:US
Practice Address - Phone:215-662-8699
Practice Address - Fax:215-243-4649
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475594208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420571500Medicaid
MD420571500Medicaid