Healthcare Provider Details

I. General information

NPI: 1659394575
Provider Name (Legal Business Name): RAYMOND REGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM STREET SUITE 239
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

1020 SANSOM STREET SUITE 239
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD049892L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: