Healthcare Provider Details

I. General information

NPI: 1427018753
Provider Name (Legal Business Name): MARK C RAYMOND MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 MAIN STREET
EXMORE VA
23350-0561
US

IV. Provider business mailing address

PO BOX 561
EXMORE VA
23350-5061
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-5079
  • Fax: 757-442-4685
Mailing address:
  • Phone: 757-442-5079
  • Fax: 757-442-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. MARK C RAYMOND
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 757-442-5079