Provider Demographics
NPI:1831172493
Name:COLLINS, RAYMOND CRAIG (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CRAIG
Last Name:COLLINS
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:PO BOX 602437
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2437
Mailing Address - Country:US
Mailing Address - Phone:800-329-9156
Mailing Address - Fax:706-660-9390
Practice Address - Street 1:3655 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2827
Practice Address - Country:US
Practice Address - Phone:843-716-7000
Practice Address - Fax:706-660-9390
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20803207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC208037Medicaid
SCGP2672Medicaid
SCD714256573Medicare PIN
SC6573Medicare PIN
SC208037Medicaid