Provider Demographics
NPI:1932298056
Name:RAISMAN, MITCHELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:RAISMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 READING CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7761
Mailing Address - Country:US
Mailing Address - Phone:215-771-6318
Mailing Address - Fax:215-938-4297
Practice Address - Street 1:1624 READING CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-7761
Practice Address - Country:US
Practice Address - Phone:215-771-6318
Practice Address - Fax:215-938-4297
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002201L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152855Medicare ID - Type Unspecified
PAT29696Medicare UPIN