Provider Demographics
NPI:1255403176
Name:LEUSNER, CHARLES RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:LEUSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1620322085R0202X, 2085R0204X
WAMD000484162085R0202X, 2085R0204X, 2085R0202X
ME0159102085R0202X, 2085R0203X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8945559OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA0225749OtherLABOR AND INDUSTRIES-TRA
WA0225750OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA1091253Medicaid
OR500666603Medicaid
WA8945560OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA7143043OtherDSHS-MIO1
WA7820707OtherDSHS-TRA
WA8869372OtherPTAN-TRA KING CO
WA8869371OtherPTAN-UAOM
WA8869335OtherPTAN-TRA PIERCE CO
WAP00447154OtherRR MEDICARE-TRA
ME333420099Medicaid
WA8945560OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA0225750OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA0249525OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
MEM108756OtherCIGNA
WA0225749OtherLABOR AND INDUSTRIES-TRA
ME043705OtherANTHEM
NH30203319Medicaid
WAG8882012OtherPTAN-MIO1
WA7087158OtherDSHS-UAOM
WA8869372OtherPTAN-TRA KING CO
WA8945559OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
ME333420099Medicaid