Provider Demographics
NPI:1871538900
Name:LESSER, RAYMOND W (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
Last Name:LESSER
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 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-790-1553
Mailing Address - Fax:215-735-4977
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-790-1553
Practice Address - Fax:215-735-4977
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035533E207Y00000X
NJ25MA05374200207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010525760004Medicaid
PA040014829OtherRAILROAD MEDICARE
NJ3934705Medicaid
NJP00082329OtherRAILROAD MEDICARE
NJP00082329OtherRAILROAD MEDICARE
PA416032Medicare ID - Type UnspecifiedMEDICARE OF PA
NJ3934705Medicaid