Provider Demographics
NPI:1578339081
Name:JOHNSTON, RAYMOND DAVID
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DAVID
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HUNTINGTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3299
Mailing Address - Country:US
Mailing Address - Phone:440-417-5379
Mailing Address - Fax:
Practice Address - Street 1:4444 S MADISON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9571
Practice Address - Country:US
Practice Address - Phone:440-417-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 172A00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver