Provider Demographics
NPI:1619040847
Name:RAUTH, JOHN D JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:RAUTH
Suffix:JR
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERISTY RADIOLOGY
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0795530207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01007819700OtherAMERICHOICE
NJ1455582/3330327OtherAETNA
NJ1552470OtherUNITED HEALTHCARE
NJ60030289OtherHORIZON NJ HEALTH
NJ8600556OtherCIGNA
NJ0125393Medicaid
NJ2813899000OtherAMERIHEALTH/KEYSTONE/IBC
NJ01007819700OtherAMERICHOICE
NJ108065 SF5Medicare PIN