MEDICARE: DR. RAFFAELLA MARIA MARCANTONIO N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	1173	OR

General Provider Information

NPI Number	:	1073055745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFFAELLA MARIA MARCANTONIO N.D.

Provider Business Mailing Address
First Line	:	3734 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1002
Country	:	US
Telephone Number	:	716-873-8700
Fax Number	:	716-873-8701

Provider Business Practice Location Address
First Line	:	3734 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1002
Country	:	US
Telephone Number	:	716-873-8700
Fax Number	:	716-873-8701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2016
Last Update Date	:	11/13/2016

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