Provider Demographics
NPI:1770665937
Name:HONSA, RAYMOND JUDE (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JUDE
Last Name:HONSA
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5325 VINNING ST NW STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2956
Practice Address - Country:US
Practice Address - Phone:704-316-1040
Practice Address - Fax:704-316-1041
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01902208M00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922187Medicaid
WI34730800Medicaid
NC1770665937Medicaid
SCNC1740Medicaid
WI023122245Medicare PIN
I65780Medicare UPIN
NCNC9974AMedicare PIN