Provider Demographics
NPI:1477564441
Name:HARRON, RAYMOND V (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:V
Last Name:HARRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:150 SPARTAN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3208
Practice Address - Country:US
Practice Address - Phone:540-400-8777
Practice Address - Fax:540-400-8795
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050084207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12923OtherRAILROAD MEDICARE LEGACY
VA006104321Medicaid
140004949OtherRAILROAD MEDICARE
VAC01334OtherMEDICARE LEGACY GROUP NUM
140004949OtherRAILROAD MEDICARE
C12923OtherRAILROAD MEDICARE LEGACY