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General NPI Number Information
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NPI Number | 1215114475
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Entity Type | Individual
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Provider Name | BETHWEL RAORE MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 454 SATELLITE BLVD NW STE 100
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City | SUWANEE
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State | GA
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Zip | 30024-7191
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Country | US
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Telephone | 678-250-0880
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Fax | 678-963-5307
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Provider Business Mailing Address
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Address Line | 454 SATELLITE BLVD NW STE 100
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City | SUWANEE
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State | GA
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Zip | 30024-7191
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Country | US
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Telephone | 678-250-0880
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Fax | 678-963-5307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35098259
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 076431
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License Number State | GA
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