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General NPI Number Information
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NPI Number | 1699187690
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Entity Type | Organization
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Legal Business Name | RAYMOND REDICARE PC
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Dates
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Enumeration Date | 05/24/2014
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Last Update Date | 05/24/2014
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Provider Practice Location Address
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Address Line | 1278 ROOSEVELT TRL
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City | RAYMOND
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State | ME
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Zip | 04071-6604
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Country | US
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Telephone | 207-655-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 1278 ROOSEVELT TRL
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City | RAYMOND
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State | ME
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Zip | 04071-6604
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Country | US
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Telephone | 207-655-6181
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD HARRY WILKINS
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Credential | D.O.
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Telephone | 207-655-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PA342
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DO2302
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License Number State | ME
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