Basic Information
| Provider Information | |||||||||
| NPI: | 1679637664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLOYD | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102728221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2901 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102728221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D42157 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | C1-0008639 | DE | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | MD42157 | PA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 61070201 | 01 | MD | BLUE SHIELD | OTHER | F8550003 | 01 | DC | GHI | OTHER |