Provider Demographics
NPI:1629097944
Name:ISHMAN, RAYMOND MARK (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MARK
Last Name:ISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:610 WEST GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462
Mailing Address - Country:US
Mailing Address - Phone:484-532-7003
Mailing Address - Fax:610-565-0222
Practice Address - Street 1:610 WEST GERMANTOWN PIKE
Practice Address - Street 2:SUITE 340
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:484-532-7003
Practice Address - Fax:610-565-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07324200207P00000X
PAMD027392E207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine