Healthcare Provider Details

I. General information

NPI: 1003930777
Provider Name (Legal Business Name): RALPH D. RAPHAEL, PH.D.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WEST RD SUITE 150
BALTIMORE MD
21204-2325
US

IV. Provider business mailing address

21 WEST RD SUITE 150
BALTIMORE MD
21204-2325
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-0042
  • Fax: 410-825-0310
Mailing address:
  • Phone: 410-825-0042
  • Fax: 410-825-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1705
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1705
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1705
License Number StateMD

VIII. Authorized Official

Name: DR. RALPH D RAPHAEL
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 410-825-0042