Provider Demographics
NPI:1396740486
Name:RAYMOND, NORMAN DE (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DE
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NORMAN
Other - Middle Name:DE
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:150 MOREY DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1646
Mailing Address - Country:US
Mailing Address - Phone:937-644-2541
Mailing Address - Fax:937-642-7535
Practice Address - Street 1:150 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-644-2541
Practice Address - Fax:937-642-7535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003632R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0550443Medicaid
OHE85464Medicare UPIN
OHRA0635101Medicare ID - Type Unspecified