Provider Demographics
NPI:1457339434
Name:MAKHOUL, RAYMOND G (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
Last Name:MAKHOUL
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 1:1051 JOHNSTON WILLIS DR
Mailing Address - Street 2:ST. 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-320-2705
Mailing Address - Fax:804-330-2433
Practice Address - Street 1:1051 JOHNSTON WILLIS DR.
Practice Address - Street 2:ST. 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-320-2705
Practice Address - Fax:804-330-2433
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010470082086S0129X
VA0101-047008208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7304773Medicaid
VA020001488Medicare ID - Type Unspecified
VA7304773Medicaid