Provider Demographics
NPI:1508875634
Name:BADDOUR, RAYMOND JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:BADDOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CLINE AVE
Mailing Address - Street 2:STE C5
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1057
Mailing Address - Country:US
Mailing Address - Phone:419-756-6990
Mailing Address - Fax:419-756-0944
Practice Address - Street 1:370 CLINE AVE
Practice Address - Street 2:STE C5
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-756-6990
Practice Address - Fax:419-756-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0784152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH606176800OtherDEPT OF LABOR ID#
OH30022664OtherRAILROAD MEDICARE ID#
OH341934892001OtherMEDICAL MUTUAL GRP#
OH2877801Medicaid
OH000000182209OtherANTHEM PROV ID#
OHG54949Medicare UPIN
OH341934892001OtherMEDICAL MUTUAL GRP#
OH606176800OtherDEPT OF LABOR ID#