Healthcare Provider Details

I. General information

NPI: 1487755963
Provider Name (Legal Business Name): KEITH W.L. RAFAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EDDIE DOWLING HWY
NORTH SMITHFIELD RI
02896-7327
US

IV. Provider business mailing address

116 EDDIE DOWLING HWY
NORTH SMITHFIELD RI
02896-7327
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-0800
  • Fax: 401-765-5904
Mailing address:
  • Phone: 401-766-0800
  • Fax: 401-765-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD06749
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: