Provider Demographics
NPI:1568464972
Name:DUSMAN, RAYMOND E JR (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:DUSMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E. DUPONT RD.
Mailing Address - Street 2:3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:1819 CAREW ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4705
Practice Address - Country:US
Practice Address - Phone:260-481-4700
Practice Address - Fax:260-481-4808
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033566A207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00785633OtherR.R. MEDICARE
IN100321280Medicaid
IN060070557OtherRR MEDICARE
OH0783933Medicaid
IN000000641075OtherANTHEM
IN193590EMedicare PIN
INP00785633OtherR.R. MEDICARE
IN100321280Medicaid
IN264380SMedicare PIN
IN193580EMedicare PIN