Provider Demographics
NPI:1922126879
Name:LODISE, RAYMOND JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:LODISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2950 OAK RIDGE FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4902
Mailing Address - Country:US
Mailing Address - Phone:215-659-7282
Mailing Address - Fax:215-659-9179
Practice Address - Street 1:2950 OAKRIDGE FARM RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4902
Practice Address - Country:US
Practice Address - Phone:215-659-7282
Practice Address - Fax:215-659-9179
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027318L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32211Medicare UPIN