Provider Demographics
NPI:1184643488
Name:DOUGLAS, RAY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:THOMAS
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:964 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7527
Practice Address - Country:US
Practice Address - Phone:570-742-2300
Practice Address - Fax:570-742-6276
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059568L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA881703OtherBLUE SHIELD
PA14953C3ABOtherGEISINGER
PA50044499OtherBLUE CROSS
PA50044499OtherKEYSTONE
PAG44887OtherHEALTH AMERICA
PA080113566OtherRAILROAD MEDICARE
PA0015759160011Medicaid
PA232809429OtherTRICARE
PA232809429OtherTRICARE
PA0015759160011Medicaid