Provider Demographics
NPI:1679580195
Name:RAIMONDO, LOUIS J (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:RAIMONDO
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 1:595 W GRANADA BLVD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5190
Mailing Address - Country:US
Mailing Address - Phone:386-672-4222
Mailing Address - Fax:386-672-8855
Practice Address - Street 1:595 W GRANADA BLVD
Practice Address - Street 2:SUITE 2E
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5190
Practice Address - Country:US
Practice Address - Phone:386-672-4222
Practice Address - Fax:386-672-8855
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00565032084F0202X, 2084P0800X, 2084P0804X, 2084P0805X
FLME00535032084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061961200Medicaid
FL09631Medicare ID - Type UnspecifiedINDIVIDUAL
FL061961200Medicaid
FL09631YMedicare ID - Type UnspecifiedGROUP ID