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NPI Code Detail

MEDICARE: RAYMOND A. REISER M.D.

MEDICARE: RAYMOND A. REISER M.D.
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
1208000000XPediatrics Physician36624SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700107240
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND A. REISER M.D.
Provider Business Mailing Address
First Line : 455 LAKESHORE PKWY
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-4205
Country : US
Telephone Number : 803-909-6363
Fax Number : 803-909-6390
Provider Business Practice Location Address
First Line : 455 LAKESHORE PKWY
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-4205
Country : US
Telephone Number : 803-909-6363
Fax Number : 803-909-6364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2010
Last Update Date : 04/21/2026

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