MEDICARE: RAYMOND DONALD CHRONISTER ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1891789137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND DONALD CHRONISTER ATC

Provider Business Mailing Address
First Line	:	1269 DOUBLEDAY DR
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2356
Country	:	US
Telephone Number	:	410-757-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	PHYSICAL EDUCATION, FIELD HOUSE,
Second Line	:	U. S. NAVAL ACADEMY
City	:	ANNAPOLIS
State	:	MD
Zip	:	21402
Country	:	US
Telephone Number	:	410-293-4486
Fax Number	:	410-268-6814

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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