Provider Demographics
NPI:1750395364
Name:RAYBON, KELVIN B (MD)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:B
Last Name:RAYBON
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-245-7102
Mailing Address - Fax:
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-245-7102
Practice Address - Fax:540-332-5962
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16276207RH0003X
NC2007-01858207RH0003X
VA0101263122207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120939Medicaid
MS00120939Medicaid