Provider Demographics
NPI:1972594828
Name:DECKER, RAYMOND GERARD (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:GERARD
Last Name:DECKER
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 1:13911 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-320-3999
Mailing Address - Fax:804-323-9383
Practice Address - Street 1:13911 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-320-3999
Practice Address - Fax:804-323-9383
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054534207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005643058Medicaid
VA080130560OtherRAILROAD MEDICARE
VA5631149Medicaid
VA005634491Medicaid
VA272290OtherANTHEM BC
VA005634482Medicaid
VA930001362Medicare PIN
VA005634491Medicaid
VA005643058Medicaid
VA5631149Medicaid
VA080007170Medicare PIN