Provider Demographics
NPI:1396745410
Name:RAIMONDE, ANTHONY JAY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAY
Last Name:RAIMONDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST STE ACC 200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2603
Mailing Address - Country:US
Mailing Address - Phone:419-251-4283
Mailing Address - Fax:419-251-0814
Practice Address - Street 1:2213 CHERRY ST STE ACC 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-4283
Practice Address - Fax:419-251-0814
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0581762086S0102X
OH35-058176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000502923OtherANTHEM
OH00408879OtherRAILROAD MEDICARE
34-1742589OtherSUMMA
4569518OtherAETNA
01343OtherPARAMOUNT
732320OtherBUCKEYE COMMUNITY HEALTH PLAN
OH000000315352OtherANTHEM
MI4966028OtherMICHIGAN MEDICAID
6683114OtherCIGNA
OH0823309Medicaid
34-1742589OtherSUMMA
4569518OtherAETNA
OH000000315352OtherANTHEM
6683114OtherCIGNA