Provider Demographics
NPI:1427018753
Name:MARK C RAYMOND MD PC
Entity Type:Organization
Organization Name:MARK C RAYMOND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-442-5079
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350-5061
Mailing Address - Country:US
Mailing Address - Phone:757-442-5079
Mailing Address - Fax:757-442-4685
Practice Address - Street 1:3298 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EXMORE
Practice Address - State:VA
Practice Address - Zip Code:23350-0561
Practice Address - Country:US
Practice Address - Phone:757-442-5079
Practice Address - Fax:757-442-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
F64780Medicare UPIN
00V959M02Medicare ID - Type Unspecified