Provider Demographics
NPI:1720058597
Name:DECESARE, RAYMOND CHARLES II (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:DECESARE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:521 MT PLEASANT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1987
Mailing Address - Country:US
Mailing Address - Phone:570-346-7338
Mailing Address - Fax:570-341-3025
Practice Address - Street 1:521 MT PLEASANT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1987
Practice Address - Country:US
Practice Address - Phone:570-346-7338
Practice Address - Fax:570-341-3025
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-08-15
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Provider Licenses
StateLicense IDTaxonomies
PAMD067457L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017521800008Medicaid
PA026971YGDBMedicare PIN
PA0017521800008Medicaid