Healthcare Provider Details

I. General information

NPI: 1518483437
Provider Name (Legal Business Name): RACHEL A RAPHAEL MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST # 612
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST # 612
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-834-6126
  • Fax: 410-539-3418
Mailing address:
  • Phone: 410-837-6126
  • Fax: 410-539-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00538
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: