Healthcare Provider Details

I. General information

NPI: 1215219167
Provider Name (Legal Business Name): RSM MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 WIDEWATERS PKWY
EAST SYRACUSE NY
13057-3081
US

IV. Provider business mailing address

1001 W. FAYETTE ST. SUITE 400
SYRACUSE NY
13204-2856
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-0190
  • Fax:
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-883-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: IRVING GARY RAPHAEL
Title or Position: PARTNER
Credential: MD
Phone: 315-426-0190