Provider Demographics
NPI:1437372703
Name:RAYMO, CHARLES EUGENE JR (PA C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EUGENE
Last Name:RAYMO
Suffix:JR
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:2660 TATE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1465
Mailing Address - Country:US
Mailing Address - Phone:828-261-0009
Mailing Address - Fax:828-261-0799
Practice Address - Street 1:2660 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1465
Practice Address - Country:US
Practice Address - Phone:828-261-0009
Practice Address - Fax:828-261-0799
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00010-00856OtherNORTH CAROLINA LICENSE PA
NCMR1580631OtherDEA
NCMR1580631OtherDEA