Provider Demographics
NPI:1609844745
Name:SCALETTAR, RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:SCALETTAR
Suffix:
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 1:12433 ANSIN CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2904
Mailing Address - Country:US
Mailing Address - Phone:301-526-6950
Mailing Address - Fax:202-331-1489
Practice Address - Street 1:12433 ANSIN CIRCLE DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2904
Practice Address - Country:US
Practice Address - Phone:301-526-6950
Practice Address - Fax:202-331-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0011678207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB93307Medicare UPIN
DCG01557Medicare ID - Type Unspecified