Healthcare Provider Details

I. General information

NPI: 1346365293
Provider Name (Legal Business Name): SETH A RAFAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 WYMAN ST
WABAN MA
02468-1529
US

IV. Provider business mailing address

154 BEAUMONT AVE
NEWTONVILLE MA
02460-2330
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-7596
  • Fax:
Mailing address:
  • Phone: 617-332-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number157068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: