1023024585 NPI number — DR. RICHARD RAYMOND DMD

Table of content: DR. RICHARD RAYMOND DMD (NPI 1023024585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023024585 NPI number — DR. RICHARD RAYMOND DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYMOND
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023024585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 290
Provider Second Line Business Mailing Address:
139 MARKET STREET SUITE 107
Provider Business Mailing Address City Name:
FORT KENT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-834-3907
Provider Business Mailing Address Fax Number:
207-834-3908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FORT KENT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-834-3907
Provider Business Practice Location Address Fax Number:
207-834-3908
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2406 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125000000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037354 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1250000000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0806 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000-610591 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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