Provider Demographics
NPI:1649332909
Name:CHAGNON, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:CHAGNON
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 1:490 BLUE HILLS AVE
Mailing Address - Street 2:PT AND REHAB
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1513
Mailing Address - Country:US
Mailing Address - Phone:860-714-8647
Mailing Address - Fax:
Practice Address - Street 1:490 BLUE HILLS AVE
Practice Address - Street 2:PT AND REHAB
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1513
Practice Address - Country:US
Practice Address - Phone:860-714-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021539174400000X
CT21539208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist