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NPI Code Detail

MEDICARE: DEBORA J RADDER MD

MEDICARE: DEBORA J RADDER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD022971EPA

General Provider Information

NPI Number : 1598760159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORA J RADDER MD
Provider Business Mailing Address
First Line : 5241 BUFFALO RD
Second Line :
City : ERIE
State : PA
Zip : 16510-2391
Country : US
Telephone Number : 814-877-5100
Fax Number : 814-877-5121
Provider Business Practice Location Address
First Line : 5241 BUFFALO RD
Second Line :
City : ERIE
State : PA
Zip : 16510-2391
Country : US
Telephone Number : 814-877-5100
Fax Number : 814-877-5121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 05/27/2020

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