Judy, Charles Raeburn

Judy, Charles Raeburn is an individual health care provider with primary practice located at 600 Randolph St , Radford VA 24141-2428. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Judy, Charles Raeburn can be contacted via phone (540) 639-5300.

Contact Information

Primary practice address
600 Randolph St Radford VA 24141-2428
Phone: (540) 639-5300
Fax: (540) 639-4653
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101050262 Virginia

Profile Details

NPI number 1720085392
LBN Legal business name Judy, Charles Raeburn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Sep 27th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720085392 NPPES
Virginia MEDICAID 5639719
Virginia MEDICAID 010172942

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