Provider Demographics
NPI:1891758843
Name:CHEUNG, RAYNARD J (MD)
Entity Type:Individual
Prefix:
First Name:RAYNARD
Middle Name:J
Last Name:CHEUNG
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 1:10 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1107
Mailing Address - Country:US
Mailing Address - Phone:610-664-9700
Mailing Address - Fax:610-664-6391
Practice Address - Street 1:10 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 124
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1107
Practice Address - Country:US
Practice Address - Phone:610-664-9700
Practice Address - Fax:610-664-6391
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053961L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001817534Medicaid
PA024838E2PMedicare ID - Type Unspecified
PAG79532Medicare UPIN