MEDICARE: RAYMOND JUDE HONSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	2012-01902	NC
2	207R00000X	Internal Medicine Physician	2012-01902	NC

General Provider Information

NPI Number	:	1770665937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND JUDE HONSA MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 VINNING ST NW STE 101
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2956
Country	:	US
Telephone Number	:	704-316-1040
Fax Number	:	704-316-1041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/31/2023

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