Provider Demographics
NPI:1154342715
Name:DE RAMON, RICHARD A (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:DE RAMON
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 1:1955 LAMBS GAP RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1618
Mailing Address - Country:US
Mailing Address - Phone:717-612-9304
Mailing Address - Fax:
Practice Address - Street 1:2025 TECHNOLOGY PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9400
Practice Address - Country:US
Practice Address - Phone:717-791-2880
Practice Address - Fax:717-791-2885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070908L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2832624OtherAETNA HMO
PA074629OtherHIGHMARK BLUE SHEILD
PA5004230OtherCAPITAL BLUE CROSS
PA5004230OtherCAPITAL BLUE CROSS
PA037624Medicare ID - Type Unspecified
PA2832624OtherAETNA HMO