Provider Demographics
NPI:1417296997
Name:RAYMUNDO, LELWELLYN ANTONE (MD)
Entity Type:Individual
Prefix:DR
First Name:LELWELLYN
Middle Name:ANTONE
Last Name:RAYMUNDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:ANTONE
Other - Last Name:RAYMUNDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:419 CHRISLENA LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3887
Mailing Address - Country:US
Mailing Address - Phone:610-738-7680
Mailing Address - Fax:
Practice Address - Street 1:419 CHRISLENA LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3887
Practice Address - Country:US
Practice Address - Phone:610-738-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438899207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF35633Medicare UPIN