Provider Demographics
NPI:1457332181
Name:RAYMOND, MATTHEW PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PATRICK
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NORTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-628-3111
Mailing Address - Fax:860-628-3119
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2529
Practice Address - Country:US
Practice Address - Phone:860-628-3111
Practice Address - Fax:860-628-3119
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000534208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5005343Medicaid
CT250000255Medicare ID - Type Unspecified
CTG93977Medicare UPIN