Provider Demographics
NPI:1205984739
Name:DORIO, RAYMOND J (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:DORIO
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 1:24237 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2907
Mailing Address - Country:US
Mailing Address - Phone:661-288-0081
Mailing Address - Fax:
Practice Address - Street 1:24237 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2907
Practice Address - Country:US
Practice Address - Phone:661-259-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29371207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01146Medicare UPIN
CAA29371AMedicare ID - Type UnspecifiedMEDICARE BILLING NUMBER