Provider Demographics
NPI:1831282185
Name:JACKSON, RAYMOND WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:JACKSON
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 1:300 S JULIANA ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1736
Mailing Address - Country:US
Mailing Address - Phone:814-623-7279
Mailing Address - Fax:
Practice Address - Street 1:411 OAK ST
Practice Address - Street 2:STERLING MEDICAL ASSOCIATES
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2598
Practice Address - Country:US
Practice Address - Phone:513-984-1800
Practice Address - Fax:513-984-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026205E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD795479Medicaid
PAD795479Medicaid
PA46432Medicare ID - Type Unspecified