Provider Demographics
NPI:1962490235
Name:SALOMONE, RAYMOND JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:SALOMONE
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 1:1450 SOM CENTER RD
Mailing Address - Street 2:#25
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2118
Mailing Address - Country:US
Mailing Address - Phone:440-446-1423
Mailing Address - Fax:440-446-1498
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:#305
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-639-0448
Practice Address - Fax:440-639-0552
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2993207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0848873Medicaid
OH0848873Medicaid
OH0687107Medicare ID - Type Unspecified