Provider Demographics
NPI:1134325632
Name:HARRELL, RAYMOND MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MARTIN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14605 POTOMAC BRANCH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3336
Mailing Address - Country:US
Mailing Address - Phone:703-738-4371
Mailing Address - Fax:703-642-1876
Practice Address - Street 1:14605 POTOMAC BRANCH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3336
Practice Address - Country:US
Practice Address - Phone:703-738-4371
Practice Address - Fax:703-642-1876
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080491208VP0014X
VA0101257583208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine