Healthcare Provider Details

I. General information

NPI: 1992705727
Provider Name (Legal Business Name): PAUL A RAYMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 KEYSTONE AVE
CRESSON PA
16630-1214
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-4635
  • Fax: 814-886-5470
Mailing address:
  • Phone: 814-410-8300
  • Fax: 814-410-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD013554E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: