MEDICARE: DR. RAYMOND JOSEPH EMANUEL M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	MD-10452	HI

General Provider Information

NPI Number	:	1982799748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND JOSEPH EMANUEL M.D.

Provider Business Mailing Address
First Line	:	1754 OVERLOOK DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1409
Country	:	US
Telephone Number	:	202-352-5447
Fax Number	:	202-352-5447

Provider Business Practice Location Address
First Line	:	91-2301 OLD FT WEAVER RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3602
Country	:	US
Telephone Number	:	808-671-8511
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/19/2022

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