1316943491 NPI number — MARILYN CYNTHIA RAYMOND M.D.

Table of content: MARILYN CYNTHIA RAYMOND M.D. (NPI 1316943491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316943491 NPI number — MARILYN CYNTHIA RAYMOND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYMOND
Provider First Name:
MARILYN
Provider Middle Name:
CYNTHIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316943491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102222
Provider Second Line Business Mailing Address:
ATTN CREDENTIALING
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-274-8200
Provider Business Mailing Address Fax Number:
239-278-3350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 N FLAGLER DR
Provider Second Line Business Practice Location Address:
FLORIDA CANCER SPECIALISTS PL
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33401-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-366-4100
Provider Business Practice Location Address Fax Number:
561-366-4189
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  ME74719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 256340100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".