Provider Demographics
NPI:1710908298
Name:RAYMOND, ROGER D (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:RAYMOND
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 1:950 WARREN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1432
Mailing Address - Country:US
Mailing Address - Phone:401-606-1004
Mailing Address - Fax:401-606-1153
Practice Address - Street 1:950 WARREN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1432
Practice Address - Country:US
Practice Address - Phone:401-606-1004
Practice Address - Fax:401-606-1153
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04120207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000379Medicaid
RIC90590Medicare UPIN
RI007056748Medicare ID - Type Unspecified