Provider Demographics
NPI:1619009610
Name:RAGER COLON, VICKI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:RAGER COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:RAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST STE 4110
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-5665
Mailing Address - Fax:937-208-5669
Practice Address - Street 1:ONE WYOMING STREET
Practice Address - Street 2:SUITE 3120
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-5665
Practice Address - Fax:937-208-5669
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089250207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750821Medicaid