Healthcare Provider Details

I. General information

NPI: 1417298209
Provider Name (Legal Business Name): BETHESDA ALLERGY, ASTHMA, AND RESEARCH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 AUBURN AVE SUITE 202
BETHESDA MD
20814-2636
US

IV. Provider business mailing address

4915 AUBURN AVE SUITE 202
BETHESDA MD
20814-2636
US

V. Phone/Fax

Practice location:
  • Phone: 301-907-3442
  • Fax: 301-907-6835
Mailing address:
  • Phone: 301-907-3442
  • Fax: 301-907-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON DAVID RAPHAEL
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 301-907-3442