MEDICARE: MR. RAFAEL IVAN GRACIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	57974	MA

General Provider Information

NPI Number	:	1073539276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAFAEL IVAN GRACIA M.D.

Provider Business Mailing Address
First Line	:	301 LITTLE POND COUNTY RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-2810
Country	:	US
Telephone Number	:	401-787-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WASHINGTON ST
Second Line	:	CCBC
City	:	TAUNTON
State	:	MA
Zip	:	02780-3960
Country	:	US
Telephone Number	:	508-823-5400
Fax Number	:	508-880-7114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/15/2015

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