Provider Demographics
NPI:1245831981
Name:SMITH, RAYMOND ARTHUR
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 STONINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9093
Mailing Address - Country:US
Mailing Address - Phone:585-615-4218
Mailing Address - Fax:
Practice Address - Street 1:3338 STONINGTON CIR
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9093
Practice Address - Country:US
Practice Address - Phone:585-615-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide