Provider Demographics
NPI:1023127164
Name:GUILLETTE, RAYMOND A (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:GUILLETTE
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 1:303 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1752
Mailing Address - Country:US
Mailing Address - Phone:508-222-6542
Mailing Address - Fax:508-226-8552
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1752
Practice Address - Country:US
Practice Address - Phone:508-222-6542
Practice Address - Fax:508-226-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000027452OtherBMC HEALTHNET
1201592OtherUHC
200075OtherRI BLUE CHIP
MAB10057401OtherCIGNA
MA33257OtherFALLON
MA20123OtherHPHC
MA712852OtherTUFTS
MAK02074OtherMABC
MA0150371Medicaid
MA0150371Medicaid
1201592OtherUHC