MEDICARE: RONALD JOHN RAYMOND 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	207RC0000X	Cardiovascular Disease Physician	033969	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720013949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD JOHN RAYMOND MD

Provider Business Mailing Address
First Line	:	1305 POST RD
Second Line	:	LOWER LEVEL
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-6016
Country	:	US
Telephone Number	:	203-292-2000
Fax Number	:	203-255-2512

Provider Business Practice Location Address
First Line	:	30 PROSPECT ST
Second Line	:	SUITE 200
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4514
Country	:	US
Telephone Number	:	203-438-9621
Fax Number	:	203-438-4596

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/08/2007

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