Provider Demographics
NPI:1417515701
Name:CLAUDIO, RAYMUND JR
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:
Last Name:CLAUDIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HOLY FAMILY RD APT 110
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2763
Mailing Address - Country:US
Mailing Address - Phone:201-993-5492
Mailing Address - Fax:
Practice Address - Street 1:300 WESTERN BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4305
Practice Address - Country:US
Practice Address - Phone:860-657-1950
Practice Address - Fax:860-657-1951
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26NR18742200367500000X
MA26NR18742200367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered