Provider Demographics
NPI:1841388485
Name:DECESARE, RAYMOND CHARLES SR (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHARLES
Last Name:DECESARE
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-897-6272
Mailing Address - Fax:570-839-0893
Practice Address - Street 1:716 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:PA
Practice Address - Zip Code:18351-0358
Practice Address - Country:US
Practice Address - Phone:570-897-6272
Practice Address - Fax:570-839-0893
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002690L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADE041920OtherBLUE SHIELD/BLUE CROSS
PA503825OtherUS HEALTHCARE/AETNA
PA14843OtherGEISENGERS
PADE041920OtherBLUE SHIELD/BLUE CROSS
PA14843OtherGEISENGER`S
DE041920Medicare ID - Type Unspecified