Provider Demographics
NPI:1720013949
Name:RAYMOND, RONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
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 1:1305 POST RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-292-2000
Mailing Address - Fax:203-255-2512
Practice Address - Street 1:30 PROSPECT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4514
Practice Address - Country:US
Practice Address - Phone:203-438-9621
Practice Address - Fax:203-438-4596
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033969207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001339698Medicaid
CTF90769Medicare UPIN
CT060001766Medicare PIN