Healthcare Provider Details

I. General information

NPI: 1699862276
Provider Name (Legal Business Name): RAFAEL SEZAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 NORTH ST
GENEVA NY
14456-1651
US

IV. Provider business mailing address

196 NORTH ST HOSPITALIST DEPARTMENT
GENEVA NY
14456-1651
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-4303
  • Fax:
Mailing address:
  • Phone: 315-787-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number236856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: