Provider Demographics
NPI:1134108491
Name:BANZON, RAYMUND D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMUND
Middle Name:D
Last Name:BANZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PLANTERS PL
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8507
Mailing Address - Country:US
Mailing Address - Phone:540-371-0548
Mailing Address - Fax:540-371-2481
Practice Address - Street 1:2533 COWAN BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8440
Practice Address - Country:US
Practice Address - Phone:540-371-0548
Practice Address - Fax:540-371-2481
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0898263OtherAETNA HMO
VA0101048478OtherLICENSE
VA00090772OtherAETNA CAP
VA814355OtherMAMSI
VACO2375OtherMEDICARE GROUP
VA141452OtherANTHEM
VACA9037OtherMCR RAILROAD GROUP
VA005636329Medicaid
VA4265143OtherAETNA NON HMO
VA080038873Medicare PIN
VACA9037OtherMCR RAILROAD GROUP
VACO2375OtherMEDICARE GROUP