Provider Demographics
NPI:1588761639
Name:RAEZER, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:RAEZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:USURG
Other - Middle Name:ASSOCIATES
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030565L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0031117000OtherPERSONAL CHOICE ID
PA0031117000OtherAMERIHEALTH ID
PA146871OtherBLUE SHIELD PROVIDER #
PAP0034748OtherTRICARE PROVIDER ID #
PAP00252734OtherRAILROAD MEDICARE ID
PA025027OtherBLAIR MILL ADMINISTRATORS
PA12459OtherELDER HEALTH ID#
PA36158333OtherMULTIPLAN ID#
PACL6874OtherRAILROAD MEDICARE GROUP #
PA0007379020002Medicaid
PA0007380240001Medicaid
PA0031117000OtherKEYSTONE HEALTH PLAN EAST
PA0073802406OtherAMERICHOICE ID #
PA1202110002OtherCIGNA
PA4088087OtherAETNA PROVIDER #
PADES178OtherOXFORD HEALTH PLAN ID #
NJ2327902OtherNJ MEDICAID PROVIDER #
PA0031117000OtherKEYSTONE HEALTH PLAN EAST
PA36158333OtherMULTIPLAN ID#
PAB39753Medicare UPIN