Individual
LUIS AUGUSTO MARCOS RAYMUNDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HSC T15 080, STONY BROOK, NY 11794-8153
(631) 444-3490
(631) 638-7518
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
(631) 444-0650
(631) 638-4170
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
21387
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06575513
MAGNOLIA
MS
05
—
06575513
—
MS
01
—
302I449980
MEDICARE PTAN
MS
01
—
3310476
UHC
—
01
—
9576702
AETNA
MS
Enumeration date
10/12/2009
Last updated
07/05/2015
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