Provider Demographics
NPI:1871711820
Name:RIVELL, RAYMOND A (DPM)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:RIVELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GLENWOOD PL
Mailing Address - Street 2:PO BOX 247
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1732
Mailing Address - Country:US
Mailing Address - Phone:856-678-4550
Mailing Address - Fax:856-678-6272
Practice Address - Street 1:7 GLENWOOD PL
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-0247
Practice Address - Country:US
Practice Address - Phone:856-678-4550
Practice Address - Fax:856-678-6272
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00102000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3058808Medicaid
NJ137752Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ3058808Medicaid