Provider Demographics
NPI:1205893179
Name:LUNA, RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:LUNA
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 1:220 SPRING VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2653
Mailing Address - Country:US
Mailing Address - Phone:937-436-3117
Mailing Address - Fax:937-436-0730
Practice Address - Street 1:220 E SPRING VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2653
Practice Address - Country:US
Practice Address - Phone:937-436-3117
Practice Address - Fax:937-436-0730
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073231L207Q00000X
OH35073231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107795Medicaid
080134930Medicare PIN
OHG81672Medicare UPIN
OH0861817Medicare PIN
OH2107795Medicaid
OHH369190Medicare PIN
OH0861815Medicare PIN
OH0861813Medicare PIN
OH0861818Medicare PIN
OH4295111Medicare PIN