Healthcare Provider Details

I. General information

NPI: 1851326466
Provider Name (Legal Business Name): RAOUL G BINIAURISHVILI M.D.,PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11685-C BUSTLETON AVE HENDRIX CENTER
PHILADELPHIA PA
19116
US

IV. Provider business mailing address

170 CHRISTOPHER DR
PRINCETON NJ
08540-2322
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-7820
  • Fax: 215-464-7808
Mailing address:
  • Phone: 609-497-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD048245L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: