Provider Demographics
NPI:1851354237
Name:NINO, RAYMOND FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FRANK
Last Name:NINO
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 1:87 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1127
Mailing Address - Country:US
Mailing Address - Phone:724-938-7000
Mailing Address - Fax:724-938-3390
Practice Address - Street 1:87 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1127
Practice Address - Country:US
Practice Address - Phone:724-938-7000
Practice Address - Fax:724-938-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039690L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA458599Medicare ID - Type UnspecifiedPROVIDER NUMBER