Provider Demographics
NPI:1457475105
Name:WATERS, RAYMOND E III (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:WATERS
Suffix:III
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 1:1641 CRITTENDEN ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3395
Mailing Address - Country:US
Mailing Address - Phone:202-526-3870
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE NW SUITE 3400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-3395
Practice Address - Country:US
Practice Address - Phone:202-865-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD169912085R0202X
VA01010437812085R0202X
MDD382702085R0202X
MDD00382702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
620122Medicare ID - Type Unspecified
MDF05690Medicare UPIN