Provider Demographics
NPI:1891795688
Name:GREASER, RAYMOND DALE (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DALE
Last Name:GREASER
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 1:58 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3609
Mailing Address - Country:US
Mailing Address - Phone:304-217-2210
Mailing Address - Fax:304-217-2211
Practice Address - Street 1:58 16TH ST STE 410
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3610
Practice Address - Country:US
Practice Address - Phone:304-217-2210
Practice Address - Fax:304-217-2211
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34724208VP0000X, 208VP0014X
MI4301504095208VP0000X
VA0101058826208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050001470OtherMEDICARE ID-TYPE UNSPECIFIED
TX5N769OtherMEDICARE PIN
TXG90147OtherMEDICARE UPIN
TX005702593Medicaid
TX164149001Medicaid
AR164149001Medicaid
TX164149001Medicaid
TXG90147OtherMEDICARE UPIN