Healthcare Provider Details

I. General information

NPI: 1710989405
Provider Name (Legal Business Name): STEPHEN ALAN RAPHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 2ND AVE SUITE 301
COLLEGEVILLE PA
19426-3625
US

IV. Provider business mailing address

409 2ND AVE SUITE 301
COLLEGEVILLE PA
19426-3625
US

V. Phone/Fax

Practice location:
  • Phone: 610-409-8830
  • Fax:
Mailing address:
  • Phone: 610-409-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number04068142
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: