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General NPI Number Information
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NPI Number | 1417298209
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Entity Type | Organization
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Legal Business Name | BETHESDA ALLERGY, ASTHMA, AND RESEARCH CENTER, LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 4915 AUBURN AVE SUITE 202
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City | BETHESDA
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State | MD
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Zip | 20814-2636
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Country | US
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Telephone | 301-907-3442
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Fax | 301-907-6835
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Provider Business Mailing Address
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Address Line | 4915 AUBURN AVE SUITE 202
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City | BETHESDA
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State | MD
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Zip | 20814-2636
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Country | US
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Telephone | 301-907-3442
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Fax | 301-907-6835
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. GORDON DAVID RAPHAEL
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Credential | MD
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Telephone | 301-907-3442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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