Provider Demographics
NPI:1598760159
Name:RADDER, DEBORA J (MD)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:J
Last Name:RADDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2391
Mailing Address - Country:US
Mailing Address - Phone:814-877-5100
Mailing Address - Fax:814-877-5121
Practice Address - Street 1:5241 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2391
Practice Address - Country:US
Practice Address - Phone:814-877-5100
Practice Address - Fax:814-877-5121
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022971E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP000006OtherGATEWAY
PA205101OtherUPMC
NY00026416902OtherUNIVERA
PA0008255400007Medicaid
NY02157486OtherNY MEDICAID
PA156039OtherBLUE SHIELD
PA159435OtherUNISON
PAP00170520OtherRR MEDICARE
PA3729987OtherAETNA
PA159435OtherUNISON
PA156039OtherBLUE SHIELD