Healthcare Provider Details

I. General information

NPI: 1558368704
Provider Name (Legal Business Name): DAVID MARK RAFALKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVERSIDE DR
BEAVER PA
15009-3116
US

IV. Provider business mailing address

1301 RIVERSIDE DR
BEAVER PA
15009-3116
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-7800
  • Fax: 724-728-8115
Mailing address:
  • Phone: 724-728-7800
  • Fax: 724-728-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD016925E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: