Healthcare Provider Details

I. General information

NPI: 1265487623
Provider Name (Legal Business Name): STEVEN MARK RAIKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TILLMAN DR FL 2
BENSALEM PA
19020-2071
US

IV. Provider business mailing address

833 CHESTNUT ST STE 520
PHILADELPHIA PA
19107-4430
US

V. Phone/Fax

Practice location:
  • Phone: 267-339-3558
  • Fax: 267-339-3763
Mailing address:
  • Phone: 800-321-9999
  • Fax: 267-339-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number25MA07108800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME152909
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD070216L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2378279
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA
# 2
Identifier0559350000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIBC
# 3
Identifier0803514000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerIBC
# 4
Identifier2784525
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 5
Identifier2265820
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: