Healthcare Provider Details

I. General information

NPI: 1215321138
Provider Name (Legal Business Name): CHARLES RAYMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CATHERINE RAYMER

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 269-429-0900
  • Fax: 269-408-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301512245
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1013419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: