Provider Demographics
NPI:1417603309
Name:RAYMONDO, GREGORY ANTHONY (CPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ANTHONY
Last Name:RAYMONDO
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 KNOTTY OAK RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-8311
Mailing Address - Country:US
Mailing Address - Phone:401-249-4404
Mailing Address - Fax:
Practice Address - Street 1:289 COWESETT AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2271
Practice Address - Country:US
Practice Address - Phone:401-219-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIT251974