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General NPI Number Information
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NPI Number | 1629097944
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Entity Type | Individual
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Provider Name | RAYMOND MARK ISHMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 610 WEST GERMANTOWN PIKE SUITE 340
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462
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Country | US
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Telephone | 484-532-7003
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Fax | 610-565-0222
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Provider Business Mailing Address
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Address Line | 610 WEST GERMANTOWN PIKE SUITE 340
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462
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Country | US
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Telephone | 484-532-7003
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Fax | 610-565-0222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA07324200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD027392E
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License Number State | PA
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