Healthcare Provider Details

I. General information

NPI: 1902896988
Provider Name (Legal Business Name): RAQUEL B EMPEDRAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAQUEL B BALADAJIA M.D.

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N BROAD ST SUITE 300
PHILADELPHIA PA
19107-1554
US

IV. Provider business mailing address

205 N BROAD ST SUITE 300
PHILADELPHIA PA
19107-1554
US

V. Phone/Fax

Practice location:
  • Phone: 215-569-1111
  • Fax: 215-569-8797
Mailing address:
  • Phone: 215-569-1111
  • Fax: 215-569-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA08062300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD428661
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: