Provider Demographics
NPI:1013000983
Name:USURG ASSOCIATES INC
Entity Type:Organization
Organization Name:USURG ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAEZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-534-6100
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:SUITES 12 AND 16
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3522
Mailing Address - Country:US
Mailing Address - Phone:610-534-6100
Mailing Address - Fax:610-534-6104
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:SUITES 12 AND 16
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3522
Practice Address - Country:US
Practice Address - Phone:610-534-6100
Practice Address - Fax:610-534-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030565L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007379020002Medicaid
PA0031122000OtherKEYSTONE PROVIDER ID #
PA0031122000OtherAMERIHEALTH PROV ID #
PAP3615833OtherMULTIPLAN PROVIDER ID #
NJ3537609Medicaid
0405110001Medicare NSC
PA0031122000OtherKEYSTONE PROVIDER ID #
PA0007379020002Medicaid
PAP3615833OtherMULTIPLAN PROVIDER ID #