Provider Demographics
NPI:1760444087
Name:KOSTIN, RAYMOND F (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:F
Last Name:KOSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 S FRONT ST
Practice Address - Street 2:4TH FL, BMA
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-231-8555
Practice Address - Fax:717-231-8568
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031429L208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000593965Medicaid
PAB35455Medicare UPIN
PA000593965Medicaid